title: Avascular necrosis in HIV.
abstract: Avascular necrosis (AVN) is an emerging complication of HIV infection. The incidence of AVN in HIV patients is greater than the general population. Although the incidence has increased in the HAART era, the aetiology remains unclear. We report our experience of AVN from our tertiary referral HIV centre and evaluate risk factors for its development. Review of MRI reports of HIV-positive patients between 2007 and 2010 identified 22 patients with AVN (19 men, 3 women). Case notes and electronic records were reviewed. Twenty-two patients developed AVN, among 6,487 HIV patients attending our centre (0.34% incidence; 95% CI, 0.2-0.48%). 68% of patients had multi-joint involvement. The median nadir CD4 count was 52 cells/μL. 73% of patients had more than two risk factors including HAART (91%), protease inhibitors (68%), hypercholesterolaemia (59%), corticosteroids (55%), hypertriglyceridaemia (45%), smoking (45%), alcohol (27%) and CD4 <200 cells/μL (23%). 9% were idiopathic. AVN is an important musculoskeletal manifestation of HIV and may be multi-focal with multi-factorial aetiology. Preventative strategies should focus on risk factor modification. When investigating joint pain in HIV-infected patients, clinicians should maintain a high index of suspicion for AVN. Unexplained AVN, particularly if multi-focal, should prompt consideration of HIV testing.
authors.affiliation: Department of Rheumatology, Chelsea and Westminster Hospital, London, UK.
authors.forename: Puja
authors.initials: P
authors.lastname: Mehta
authors.forename: Mark
authors.initials: M
authors.lastname: Nelson
authors.forename: Alexander
authors.initials: A
authors.lastname: Brand
authors.forename: Fiona
authors.initials: F
authors.lastname: Boag
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D017320:HIV Protease Inhibitors / Q000009:adverse effects; D006801:Humans; D007596:Joints / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D012307:Risk Factors; D062606:Tertiary Care Centers; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors