Avascular Necrosis in HIV‐Infected Patients: A Case‐Control Study from the Aquitaine Cohort, 1997–2002, France

Lawson-Ayayi, S.; Bonnet, Fabrice; Bernardin, Elise; Ragnaud, Jean‐Marie; Lacoste, D.; Malvy, Denis; Blaizeau, Marie-Josée; Miremont-Salamé, Ghada; Dupon, M.; Mercié, P.; Dabis, François

doi:10.1086/428837

Cited by 28 publications

(35 citation statements)

References 27 publications

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“…4,6,9,11 Our data for steroid exposure are broadly comparable to that of Fessel et al, 13 in terms of aggregate corticosteroid dose given per month prior to AVN diagnosis and the dose given in the year prior to AVN diagnosis. In addition, the proportion who had received corticosteroids in the year prior to AVN diagnosis was 5/15 (33%) in our data compared with (3/12) 25% for Fessel et al Suggestions of how steroid exposure mediates cell death include increased apoptosis through activation of free radicals and inflammatory mediators, 4 increased intraosseous pressure due to fat infiltration of bone marrow causing obstruction in small blood vessels 11 or fat embolization in vessels through secondary hyperlipidaemia.…”

Section: Discussionsupporting

confidence: 79%

“…Established risk factors for AVN in individuals without HIV (such as alcohol abuse, corticosteroid use, coagulopathies) may be more prevalent in those with HIV. [4][5][6][7][8][9][10][11] Moreover, it has been suggested that HIV infection itself and antiretroviral therapy (ART), particularly protease inhibitors (PIs), 12 may increase AVN risk. This study investigates the association of AVN in HIV-positive individuals with possible risk factors including ART.…”

Section: Introductionmentioning

confidence: 99%

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Avascular necrosis in HIV patients: a case–control study

et al. 2013

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This study investigates the association of avascular necrosis (AVN) in human immunodeficiency virus (HIV)-positive individuals with possible risk factors, including antiretroviral therapy. Clinic records of all AVN cases diagnosed up to July 2009 in HIV-positive patients attending North Middlesex Hospital, London, UK were retrospectively reviewed. For each case, one control was randomly selected, matched for gender, age, nadir CD4 count and date of HIV diagnosis. Of 15 symptomatic AVN cases identified, eight were in women. Univariate analysis demonstrated significant associations between AVN and a history of systemic steroid use (p = 0.004) and cumulative exposure to protease inhibitor (p = 0.03). Physicians should be aware of the risk of AVN with steroid use, the importance of early diagnosis and avoidance of other risk factors in order to prevent further joint involvement if possible.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Avascular necrosis in HIV patients: a case–control study

et al. 2013

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“…This hypothesis was supported by a univariable association of AVN with a CD4 nadir >200 cells/µL and corticosteroid use >3 months. Prolonged corticosteroid treatment is more often used in late presenters (eg, as adjunctive treatment to opportunistic infections) or subsequent to ART start (eg, management of immune reconstitution inflammatory syndrome) [5, 6, 10, 12, 20, 21]. In contrast to other studies, we did not observe an association with the use of testosterone or megestrol acetate.…”

Section: Discussioncontrasting

confidence: 99%

“…In contrast to other studies, we did not observe an association with the use of testosterone or megestrol acetate. Alcohol use has previously been reported as a risk factor for AVN among HIV-positive persons [6, 10, 20, 21]. The longitudinal design of the SHCS including our quantitative assessment of alcohol consumption at 6-monthly intervals in the SHCS since 2008 [13] allowed us to extend these findings.…”

Section: Discussionmentioning

confidence: 74%

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Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Bayard

Ledergerber

Flepp

et al. 2017

Open Forum Infectious Diseases

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BackgroundHIV-infected individuals have an increased risk of avascular bone necrosis (AVN). Antiretroviral therapy (ART) and particularly protease inhibitors (PI) have been implicated as a risk factor. We aimed to study the associations of ART with the occurrence of AVN among Swiss HIV Cohort Study participants (SHCS).MethodsWe used incidence density sampling to perform a case control study within the Swiss HIV Cohort Study (SHCS) comparing prospectively collected AVN cases and controls by conditional logistic regression analysis. To evaluate the effect of ART, multivariable models were adjusted for HIV transmission risk group, age, alcohol consumption, use of corticosteroids, CD4 nadir, maximum viral load, and pancreatitis.ResultsWe compared 74 AVN cases and 145 controls. Associations with AVN were shown for heterosexual HIV acquisition (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1–10), alcohol consumption (OR, 2.7; 95% CI, 1.3–5.7), and hyperlipidemia (OR, 3.6; 95% CI, 1.4–9.6). After adding ART substances to the multivariable base model, there was evidence of an association for treatment with tenofovir (TDF) >1 year (OR, 4.4; 95% CI, 1.4–14) with AVN. Neither exposure to specific frequently prescribed ART combinations or ART drug classes nor cumulative ART exposure showed any associations with AVN.ConclusionsIn the HIV-infected population, a combination of risk factors such as heterosexual HIV acquisition, moderate to severe alcohol intake, and hyperlipidemia seem to contribute to AVN. ART does not seem to be a relevant risk factor for AVN. The association of prolonged TDF exposure with AVN needs to be confirmed.

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Unfavorable hip stress distribution after Legg–Calvé–Perthes syndrome: A 25‐year follow‐up of 135 hips

Kocjančič

Moličnik

Antolič

et al. 2013

Journal Orthopaedic Research

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To study the effect of hip and pelvis geometry on development of the hip after Perthes disease, we determined the resultant hip force and contact hip stress distribution in a population of 135 adult hips of patients who had been treated for Perthes disease in childhood. Contra-lateral hips with no record of disease were taken as the control population. Biomechanical parameters were determined by mathematical models for resultant hip force in one-legged stance and for contact hip stress, which use as an input the geometrical parameters assessed from anteroposterior radiographs. The mathematical model for stress was upgraded to account for the deviation of the femoral head shape from spherical. No differences were found in resultant hip force and in peak contact hip stress between the hips that were in childhood subject to Perthes disease and the control population, but a considerable (148%) and significant (p < 0.001) difference was found in the contact hip stress gradient index, expressing an unfavorable, steep decrease of contact stress at the lateral acetabular rim. This finding indicates an increased risk of early coxarthritis in hips subject to Perthes disease. ß

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Avascular Necrosis in HIV‐Infected Patients: A Case‐Control Study from the Aquitaine Cohort, 1997–2002, France

Cited by 28 publications

References 27 publications

Avascular necrosis in HIV patients: a case–control study

Avascular necrosis in HIV patients: a case–control study

Associations Between Antiretroviral Treatment and Avascular Bone Necrosis: The Swiss HIV Cohort Study

Unfavorable hip stress distribution after Legg–Calvé–Perthes syndrome: A 25‐year follow‐up of 135 hips

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