QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Molia, A. C Articles by Trenque, T. C Search for Related Content PubMed PubMed Citation Articles by Molia, A. C Articles by Trenque, T. C

Osteonecrosis in Six HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy

Clinical Pharmacist, Pharmacovigilance Regional Center, CHU, Reims, France

Christophe Strady, MD

Clinical Specialist, Department of Infectious Diseases, CHU, Reims

Christine Rouger, MD

Clinical Specialist, Department of Infectious Diseases, CHU, Reims

Isabelle M Beguinot, MD

Clinical Specialist, Department of Infectious Diseases, CHU, Reims

Jean-Luc Berger, MD

Clinical Specialist, Department of Infectious Diseases, CHU, Reims

Thierry C Trenque, MD PhD

Director, Pharmacovigilance Regional Center

Reprints: Aurélie C Molia PharmD, Pharmacovigilance Regional Center, CHU, 45 Rue Cognacq-Jay, 51092 Reims Cedex, France, fax 33-3-26-78-84-56, pharmacovigilance{at}chu-reims.fr

OBJECTIVE: To report 6 cases of osteonecrosis in HIV-infected patients treated with highly active antiretroviral therapy (HAART) and compare the observed risk factors with those of published cases.

CASE SUMMARIES: Osteonecrosis was diagnosed between 1999 and 2002 in 6 of 417 HIV-infected patients in our department of infectious diseases. At the time of diagnosis, mean patient age was 42 years, and 5 patients had developed AIDS. Mean CD4+ lymphocyte count was 563.5 cells/mm³ and viral load was undetectable (<50 copies/mL) in 5 patients. The patients' mean body mass index was 22.5 kg/m². Four had lipodystrophy. All were receiving HAART, including a protease inhibitor in 4 patients; the remaining 2 patients had a history of protease inhibitor treatment. Median time from the first antiretroviral therapy to osteonecrosis diagnosis was 46.5 months. Established risk factors were the use of corticosteroids in 2 patients and dyslipidemia in all patients. All of the patients developed pain and functional impotence of the hip or ankle joints. Osteonecrosis of the hip was bilateral in 4 cases. Three patients required surgical intervention, all of whom had favorable outcomes.

DISCUSSION: HIV-infected patients are at a higher risk for the development of osteonecrosis and are more likely to be exposed to predisposing factors to its development. The HAART implication as a predisposing factor remains controversial.

CONCLUSIONS: The pathogenesis of osteonecrosis in HIV-infected individuals may be multifactorial; the reasonable approach for clinicians consists of treating concomitant predisposing conditions that might further cause osteonecrosis.

Key Words: avascular necrosis of bone, bone diseases, HIV, osteonecrosis, protease inhibitors, risk factors

Published Online, October 26, 2004. www.theannals.com, DOI 10.1345/aph.1E154

This article has been cited by other articles:

				G. de Larranaga, E. Bottaro, M. Martinuzzo, R. Figueroa, M. L. Iglesias Varela, S. Peres Wingeyer, R. Forastiero, Y. Adamczuk, M. Corti, L. Puga, et al. Thrombophilia in Human Immunodeficiency Virus--Infected Patients with Osteonecrosis: Is There a Real Connection? The First Case-Control Study Clinical and Applied Thrombosis/Hemostasis, June 1, 2009; 15(3): 340 - 347. [Abstract] [PDF]

				J. Richardson, A. M. Hill, C. J. C. Johnston, A. McGregor, A. R. Norrish, D. Eastwood, and C. B. D. Lavy Fracture healing in HIV-positive populations J Bone Joint Surg Br, August 1, 2008; 90-B(8): 988 - 994. [Abstract] [Full Text] [PDF]

				M. A. Mont, L. C. Jones, and D. S. Hungerford Nontraumatic Osteonecrosis of the Femoral Head: Ten Years Later J. Bone Joint Surg. Am., May 1, 2006; 88(5): 1117 - 1132. [Abstract] [Full Text] [PDF]