Avascular osteonecrosis of the femoral head in three West African HIV-infected adults with heterozygous sickle cell disease.
Three men (aged 33, 44 and 45 years, CD4(+) T-cell nadir 86 cells/mm(3), 99 cells/mm(3) and 12 cells/mm(3), respectively) were admitted to the Department of Infectious Diseases (Treichville Hospital, Abidjan, Côte d'Ivoire) for hip pain and impaired mobility. Their last available CD4(+) T-cell counts were 243 cells/mm(3), 245 cells/mm(3) and 8 cells/mm(3), respectively. They had all received antiretroviral therapy for >4 years, including lopinavir/ritonavir for >8 months. The other risk factors were hypertriglyceridaemia (n=3), smoking addiction (n=2), alcohol consumption (n=2) and lipodystrophy (n=1). All three patients had heterozygous haemoglobin AS sickle cell disease (percentage of haemoglobin S 41%, 45% and 50%, respectively). The diagnosis of avascular osteonecrosis of the femoral head (unilateral n=2 and bilateral n=1) was documented by CT scan. Only one patient underwent surgical arthroplasty. In resource-limited settings, avascular osteonecrosis is uneasy to diagnose and unlikely to be appropriately treated. Physicians should be aware of its symptoms and risk factors, including HIV infection and antiretroviral therapy. Future studies should explore whether these risk factors might include haemoglobin AS sickle cell disease, a common trait in the West African general population.
Eholié
Serge P
SP
Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire. speholie@afnet.net
Ouiminga
Mariama
M
Ehui
Eboi
E
Nzunetu
Gustave
G
Ouattara
Songda I
SI
Konan
Alexis V
AV
Anglaret
Xavier
X
Bissagnéné
Emmanuel
E
D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000235:genetics; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D007560:Cote d'Ivoire; D005271:Femur Head Necrosis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006579:Heterozygote; D006615:Hip / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain; D012307:Risk Factors
D044966:Anti-Retroviral Agents