Avascular necrosis of the femoral head in HIV infected patients

Abstract

Avascular necrosis (AVN) of the femoral head is an emerging complication in HIV infected patients. It has been suggested that the increased incidence of AVN in this population may be caused by an increased prevalence of predisposing factors for osteonecrosis, including protease inhibitors, hyperlipidemia, corticosteroid use, alcohol and intravenous drug abuse. The aim of this study was to assess the risk factors for avascular necrosis developing in the femoral head of HIV infected individuals. This study consisted of meta-analysis of the secondary data extracted from current literature. The selected articles allowed two study groups to be drawn up for comparison. Group 1 comprised 324 individuals infected by the HIV virus, who did not present femoral head AVN. Group 2 comprised 32 HIV positive patients, who presented femoral head AVN. The parameters used for analysis were as follows: age, gender, sexual preference, use of intravenous drugs, time of diagnosis, CD4+ cell count, use of antiretroviral agents and duration, serum cholesterol and serum triglycerides. The present study found a statistically significant association between hypertriglyceridemia, hypercholesterolemia, sexual preference and intravenous drug abuse. The authors concluded that femoral head osteonecrosis is associated with hyperlipidemia (hypercholesterolemia and hypertriglyceridemia) and intravenous drug abuse. This study supports the hypothesis that protease inhibitors play a role in the development of osteonecrosis through a tendency to cause hyperlipidemia.

Trabecular bone microstructure is impaired in the proximal femur of human immunodeficiency virus-infected men with normal bone mineral density

“…Importantly, our data show that even with the small sample size, we were able to detect differences in trabecular microstructure using high resolution imaging techniques. Furthermore, the trabecular bone impairment which was most significant in the femoral head might be attributable to AVN which is prevalent in HIV infected subjects (4,5). However, we do not have conclusive evidence of AVN in these subjects.…”

“…Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) are established independent risk factors for osteoporosis and elevated prevalence of fracture (1-3) as well as avascular necrosis (AVN) (4,5). Areal bone mineral density (aBMD) derived from dual X-ray absorptiometry (DXA) is the standard clinical parameter for the diagnosis of osteoporosis and assessment of risk of osteoporotic bone fracture (6,7).…”

Osteonecrosis of the femoral head: diagnosis and classification systems

“…Many studies [29][30][31] have shown an association of ON in HIVpositive individuals undergoing antiretroviral therapy. It is unknown whether or not the association is due to protease inhibitors alone or is multifactorial in combination with other risk factors such as the HIV infection itself, a history of systemic corticosteroid use, or hyperlipidemia [32][33][34][35].…”

Fracture management in HIV positive individuals: a systematic review

“…It is now well established that any stage of HIV infection is associated with osteonecrosis, due to interruption in osseous blood supply, although no mechanism for this has been shown [17][18][19]. ART has also been reported to contribute to this pathology [18].…”