Osteonecrosis in patients with human immunodeficiency virus type 1 infection in Taiwan.
Osteonecrosis, a disabling complication associated with antiretroviral therapy (ART) and human immunodeficiency virus (HIV) infection, has rarely been reported in an Asian population. After an observation of 3,250 person-years (PY), 11 of 967 (1.1%) HIV-infected patients at a median age of 34 years developed osteonecrosis involving the hip joints (incidence, 3.4 per 1,000 PY). Their median CD4+ lymphocyte count had increased from 35 cells/microL at the diagnosis of HIV infection to 297 cells/microL at the diagnosis of osteonecrosis. The crude rate of osteonecrosis increased from 0% in patients without exposure to ART to 2.6 and 1.7% in patients with exposure to nucleoside reverse transcriptase inhibitors (NRTIs) and who had undergone highly active antiretroviral therapy (HAART) for 5 years or longer, respectively (P=0.18 and 0.09, respectively). Among the patients receiving HAART, the estimated incidence of osteonecrosis was 4.2 per 1,000 PY. Patients with osteonecrosis had a longer duration of exposure to NRTIs (1,641 versus 1,264 days, P=0.26) and to HAART (1,603 versus 1,251 days, P=0.42), a higher serum triglyceride (median, 1,130 versus 351 mg/dL; P=0.09), and a higher proportion of lipodystrophy (81.8 versus 15.0%, P<0.0001). Our report suggests that osteonecrosis is a rare complication in HIV-infected patients with prolonged exposure to ART with resultant metabolic complications.
Ho
Ya-Chi
YC
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Shih
Tiffany T F
TT
Lin
Yu-Hui
YH
Hsiao
Chin-Fu
CF
Chen
Mao-Yuan
MY
Hsieh
Szu-Min
SM
Sheng
Wang-Huei
WH
Sun
Hsin-Yun
HY
Hung
Chien-Ching
CC
Chang
Shan-Chwen
SC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D013624:Taiwan / Q000453:epidemiology
D019380:Anti-HIV Agents