Osteonecrosis of the femoral head in patients with type 1 human immunodeficiency virus infection: clinical analysis and review

Abstract

Osteonecrosis of the femoral head (ONFH) typically affects relatively young, active patients and frequently follows an unrelenting course resulting in considerable loss of function. In human immunodeficiency virus-infected patients, ONFH is a growing problem. Etiology, pathogenesis, and treatment of ONFH in these patients remain controversial. We analyzed retrospectively patients with ONFH in a series of 815 patients followed in our AIDS reference center. Six patients out of the 815 were affected by ONFH (0.74%). The sex ratio was 1. Two of the six patients (33.3%) had no evidence of risk factor, whereas four patients (66.6%) had risk factors. One patient had three cumulated risk factors which were corticosteroids, chemotherapy, and radiotherapy. For this patient, the onset time for ONFH was shorter (36 months). It is difficult to attribute the effect to any single class of antiretroviral agents because combination therapy is standard of care, and a change in therapies is common. All classes of antiretroviral drugs have been used: protease inhibitors (mean use duration of 15.2 months before the ONFH onset), non-nucleoside reverse transcriptase inhibitors (12 months), and nucleoside reverse transcriptase inhibitors (40.5 months). ONFH was bilateral in four cases (66.6%) and unilateral in two cases (33.3%). One patient had other osteonecrosis location (both shoulders). ONFH was classified on plain radiography stage IV in five patients and stage III in one patient. All patients received initial medical treatment. It consisted of painkillers and non-weight bearing of the hip. All were finally operated on by total hip arthroplasty (THA). The average interval between ONFH diagnosis and the first THA was 10.3 months for the six patients. A controlateral THA was performed for three patients after a mean interval of 23.3 months after ONFH diagnosis. Of the nine implanted prostheses, four were cemented, four were cementless, and one was resurfacing prosthesis.

Does HIV Infection Increase the Risk of Perioperative Complications After THA? A Nationwide Database Study

“…At least 33% of patients with HIV receiving THA are estimated to have osteonecrosis [11,13,17,22]. Furthermore, patients with HIV have been found to have a higher risk for hip fracture [6].…”

Factors Associated with Aseptic Osteonecrosis in Hospital Settings in Yaounde, Cameroon

“…The observed contrast is difficult to interpret. For most of patients in their study, steroid treatment was addressing an underlying disease, like systemic lupus erythematosus, that might have added to causing bone lesion [21]- [23]. However, corticotherapy is also incriminated in the genesis of aseptic osteonecrosis in SLE [15] [23].…”

Total hip replacement in patients with history of illicit injecting drug use

“…Furthermore, the prevalence of infection with hepatitis B, C and human immunodeficiency virus is estimated to be greater than 60 % [2] and 12 % [3], respectively. In HIV patients undergoing antiviral therapy, the risk of osteonecrosis of the femoral head (ONFH) is increased [4][5][6], with a prevalence of approximately 0.74 % [4]. ONFH, together with inflammatory arthropathies due to repetitive bacteremia [7] and posttraumatic conditions are the main reasons for secondary hip osteoarthritis in illicit injecting drug users.…”