Osteonecrosis in HIV: A case-control study

Background: Osteonecrosis (avascular necrosis) has been infrequently report ed in HIV-infected patients. It is not known whether HIV itself is an indep endent risk factor for osteonecrosis. Methods: We identified 25 patients with osteonecrosis from 1984 to 1999 fro m a large county teaching hospital and two large practices in Dallas County that specialize in HIV-disease related therapy. A retrospective chart revi ew was performed to evaluate potential risk factors for osteonecrosis. Each case was matched with two controls for HIV positive status and date of ost eonecrosis diagnosis. Results: In the study, 22 of 25 (88%) case patients had at least one osteon ecrosis risk factor compared with 24 of 50 (48%) controls, p = .003. The mo st common osteonecrosis risk factors were hyperlipidemia (32%), alcoholism (28%), pancreatitis (16%), corticosteroids (12%), and hypercoaguability (12 %). Of the cases, 12% were idiopathic. Multiple joints were involved in 72% of cases. Four of the case patients compared with none of the controls rec eived megesterol acetate before the diagnosis of osteonecrosis, p = .01. No significant differences were found between cases and controls with respect to liver function tests, testosterone levels, triglyceride levels, cholest erol levels, or CD4 cell counts. Saquinavir was independently associated wi th osteonecrosis, p < .05, However, no differences in overall use of protea se inhibitors among cases and controls were noted: 79% versus 76%, respecti vely. Conclusions: The increased incidence of osteonecrosis in HIV/AIDS may be du e to an increased frequency of risk factors previously associated with oste onecrosis such as hyperlipidemia, corticosteroid use, alcohol abuse, and hy percoaguability. Use of protease inhibitors was not independently associate d with osteonecrosis.