title: Osteonecrosis in patients infected with HIV: clinical epidemiology and natural history in a large case series from Spain.
abstract: BACKGROUND
  There is a paucity of data on clinical epidemiology of osteonecrosis in HIV-infected patients. We aimed to describe patients' characteristics and natural history of this poorly known condition.
  
  
  METHODS
  All cases of symptomatic HIV-related osteonecrosis diagnosed from 1990 through 2003 in 19 Spanish clinics were reviewed. Functional status at the last visit was assessed with the validated Western Ontario and McMaster Universities Index questionnaire.
  
  
  RESULTS
  Of 54 patients analyzed, 29 (53.7%) had a single bone necrosis, and 25 (46.3%) had 2 or more sites involved. Progression of symptoms happened more often in patients with hip involvement (17/39 vs 0/8 patients; P = 0.019). Twenty patients (37%) required surgical intervention. Male sex and higher CD4 cell count were associated with surgery on multivariable analysis. Overall, at the end of the follow-up period, half of the patients had moderate to severe disability (Western Ontario and McMaster Universities Index score > or =60). During a follow-up period of 137 person-years, only 2 new episodes of osteonecrosis were observed (rate of recurrences, 1.5/100 person-years; 95% confidence interval, 0.4-5.1).
  
  
  CONCLUSIONS
  HIV-related osteonecrosis is associated with significant disability over time. Location of bone necrosis, sex, and CD4 cell count may influence the outcome. The risk for recurrences for patients who have experienced 1 episode is low.
authors.affiliation: Infectious Diseases Unit, Internal Medicine Department, Hospital General Universitario de Elche, Alicante, Spain. gutierrez_fel@gva.es
authors.forename: Félix
authors.initials: F
authors.lastname: Gutiérrez
authors.forename: Sergio
authors.initials: S
authors.lastname: Padilla
authors.forename: Mar
authors.initials: M
authors.lastname: Masiá
authors.forename: Juan
authors.initials: J
authors.lastname: Flores
authors.forename: Vicente
authors.initials: V
authors.lastname: Boix
authors.forename: Esperanza
authors.initials: E
authors.lastname: Merino
authors.forename: Josefa
authors.initials: J
authors.lastname: Galindo
authors.forename: Enrique
authors.initials: E
authors.lastname: Ortega
authors.forename: José
authors.initials: J
authors.lastname: López-Aldeguer
authors.forename: Carlos
authors.initials: C
authors.lastname: Galera
mesh_terms: D000328:Adult; D004198:Disease Susceptibility; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010020:Osteonecrosis / Q000150:complications* / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology