Osteonecrosis in human immunodeficiency virus (HIV)-infected patients: a multicentric case-control study.
Osteonecrosis (ON) is a rare disabling complication occurring in patients with human immunodeficiency virus (HIV) infection at a higher frequency than in the general population despite effective combination antiretroviral therapy being made available, as recently documented by several retrospective studies. We designed a multicentric case-control study among HIV-infected patients cared for at institutions in the Italian CISAI group (Italian Study Group for Adverse Events in HIV Infection) to search for additional predictors of ON in this special population. All centers which observed at least one case of ON were requested to report data for central re-evaluation. Parallel HIV-positive, ON-free controls were randomly selected and matched with confirmed cases of ON for sex, age and CD4 T-cell counts at the time of HIV diagnosis. Fifteen cases and controls were included in the final sample. Univariate statistical analyses revealed a significant association between ON and exposure to steroids (P = 0.001), exposure to one or more drugs in addition to HAART (Highly Active Anti-Retroviral Therapy) (P = 0.03), high titers of total serum IgE (P = 0.02), loss of working ability (P = 0.03), triglycerides levels over 200 mg/dL before antiretrovirals (P = 0.03) and cholesterol levels over 200 mg/dL before and after antiretrovirals (P = 0.03 and 0.05, respectively). High serum IgE levels and loss of working ability in advance of ON appeared for the first time as possible predictors of ON in HIV patients, while long-term exposure to steroids, combined hyperlipemia and chronic treatment with other drugs in addition to antiretrovirals were confirmed. Predicting and preventing ON in the individual HIV-infected patient is therefore a clinically challenging opportunity.
Unità di Malattie Infettive, Ospedale Civile Spirito Santo, Via C. Barbella 10, 65126 Pescara, Italy.
Elena
E
Mazzotta
Adriana
A
Agostinone
Raffaella
R
Rosso
Antonio
A
Di Biagio
Giuseppe Vittorio
GV
De Socio
Anna
A
Cappelletti
Raffaele
R
Zicolella
Ennio
E
Polilli
Paolo
P
Bonfanti
Luigi
L
Di Matteo
Lamberto
L
Manzoli
Giustino
G
Parruti
D000328:Adult; D016022:Case-Control Studies; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000150:complications*
Clin Infect Dis. 2003 Apr 1;36(Suppl 2):S101-5
12652379
Fam Med. 2002 Mar;34(3):201-5
11922536
J Acquir Immune Defic Syndr. 2000 Sep 1;25(1):19-25
11064500
Toxicol Appl Pharmacol. 2007 Oct 1;224(1):60-71
17669453
J Clin Epidemiol. 1996 Feb;49(2):203-9
8606321
Clin Infect Dis. 2007 Mar 1;44(5):739-48
17278070
HIV Clin Trials. 2003 Mar-Apr;4(2):132-6
12671781
Arch Fam Med. 2000 Mar;9(3):291-4
10728119
Arch Intern Med. 1998 Jul 13;158(13):1434-9
9665352
Lancet. 2008 Apr 26;371(9622):1417-26
18387667
Reumatismo. 2004 Jul-Sep;56(3):202-10
15470526
Cardiol J. 2008;15(2):122-8
18651396
Biochem Soc Trans. 2007 Nov;35(Pt 5):1104-8
17956289
Int J Cardiol. 1995 Nov 10;52(1):77-81
8707440
Coron Artery Dis. 1993 Nov;4(11):1029-32
8173709
Eur J Radiol. 2007 Jul;63(1):16-28
17555906
Obesity (Silver Spring). 2009 Dec;17 Suppl 3:S3-S14
19927143
Crit Rev Immunol. 2000;20(6):477-96
11396683
Chest. 1993 Jul;104(1):61-4
8325118
AIDS. 2006 Aug 1;20(12):1627-35
16868444
J Acquir Immune Defic Syndr. 2006 Jul;42(3):286-92
16763523
Radiology. 2000 Oct;217(1):188-92
11012443
Int J Cardiol. 1991 May;31(2):199-204
1869329
Stroke. 2006 Jun;37(6):1583-633
16675728
J Infect Dis. 2002 Feb 15;185(4):456-62
11865397
BMC Musculoskelet Disord. 2006 Mar 09;7:24
16526954
J Infect Dis. 2001 Aug 15;184(4):519-23
11471113
J Immunol. 2000 Jan 15;164(2):589-95
10623799
HIV Med. 2004 Nov;5(6):421-6
15544694
AIDS. 2003 Jan 3;17(1):1-9
12478064
Ann Intern Med. 2002 Jul 2;137(1):17-25
12093241