Thrombophilia in human immunodeficiency virus-infected patients with osteonecrosis: Is there a real connection? The first case-control study.
Several reports have described an increased incidence of osteonecrosis in human immunodeficiency virus-infected patients (HIV+), but the cause has not been established. The association between thrombophilia and osteonecrosis in HIV+ was studied. A case-control study in HIV+, 19 cases and 38 controls, was designed. Magnetic resonance imaging was made in both groups to confirm or exclude hip osteonecrosis. The extensive tests of thrombophilia were measured, and the clinical data were recorded, nadir of CD4(+) cell count and well-known risk factors for osteonecrosis. Thrombophilia has been frequently found both in patients with and without osteonecrosis (thrombophilia, 68.4% vs 60.5%), but no specific thrombophilia tests were significantly associated with osteonecrosis. A low nadir of CD4(+) (<60 cells/microL) and corticoid use were significantly (P < .05) associated with osteonecrosis. In multivariate analysis, only nadir of CD4(+) <60 cells/microL remained a predictor of osteonecrosis (odds ratio = 7.33; 95% confidence interval, 1.80-29.82, P = .005). Thrombophilia might have a limited role in the development of osteonecrosis in HIV+. Nadir of CD4(+) <60 cells/microL and corticoid use were main factors.
de Larrañaga
Gabriela
G
Hemostasis and Thrombosis Laboratory, Hospital of Infectious Diseases F. J. Muñiz, Buenos Aires, Argentina. gabriela@hemostasia.com.ar
Bottaro
Edgardo
E
Martinuzzo
Marta
M
Figueroa
Raúl
R
Iglesias Varela
María Luisa
ML
Perés Wingeyer
Silvia
S
Forastiero
Ricardo
R
Adamczuk
Yolanda
Y
Corti
Marcelo
M
Puga
Liliana
L
Benetucci
Jorge
J
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000821:virology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010020:Osteonecrosis / Q000276:immunology / Q000473:pathology / Q000821:virology*; D018570:Risk Assessment; D012307:Risk Factors; D019851:Thrombophilia / Q000276:immunology / Q000821:virology*
D000305:Adrenal Cortex Hormones