title: Avascular necrosis in HIV-infected patients receiving antiretroviral treatment: study of seven cases.
abstract: OBJECTIVE
  We analyzed clinical, radiological, scintigraphical, epidemiological, and immunological data in a group of HIV-infected patients with osteonecrosis.
  
  
  METHODS
  The first case was diagnosed in June 1997, and 6 more were identified thereafter among 1,650 attended patients (0.36%). Mean age was 37.6 years (33-46), and all were men. Mean CD4+ lymphocyte count was 501 cells/microL (98-1156), viral load was undetectable (<50 copies/mL) in 5 patients, and only 2 had AIDS diagnosis. Two patients were alcohol abusers, 1 received corticosteroids, and 3 had hypertrigliceridemia. One patient was treated with d4T plus 3TC, and the remaining received HAART. In 2 patients, lipodystrophy was simultaneously diagnosed.
  
  
  RESULTS
  Mean time between first dose of antiretroviral drugs and onset of symptoms was 12 months (2-24). All patients developed pain and functional impotence of the affected joints, and the diagnosis was confirmed by imaging techniques. Distribution of the affected sites was as follows: both hips in 5 cases, femoral external condyle in 1, and multiple joints in 1. In 4 cases, the protease inhibitor was interrupted; there was clinical improvement in 2 of these cases. The unfavorable outcome of the remaining cases required surgical intervention.
  
  
  CONCLUSIONS
  Metabolic and bone diseases should be considered a complication of HIV infection that is of growing importance.
authors.affiliation: Service of Infectious Diseases, Hospital Carlos III, Madrid, Spain. evalencia.hciii@salud.madrid.org
authors.forename: Ma Eulalia
authors.initials: ME
authors.lastname: Valencia
authors.forename: Pablo
authors.initials: P
authors.lastname: Barreiro
authors.forename: Vicente
authors.initials: V
authors.lastname: Soriano
authors.forename: Francisco
authors.initials: F
authors.lastname: Blanco
authors.forename: Victoria
authors.initials: V
authors.lastname: Moreno
authors.forename: Juan González
authors.initials: JG
authors.lastname: Lahoz
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000150:complications*; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents