title: Protease inhibitors and avascular necrosis: a systematic review and meta-analysis.
abstract: Avascular necrosis (AVN) is a pathological process associated with many medical conditions, including human immunodeficiency virus (HIV) infection. Whether or not the use of protease inhibitors (PIs) confers additional risk for AVN to HIV-infected patients is controversial. Previous epidemiological studies showed an increased risk of AVN among PI users, but these studies did not have enough power to achieve statistical significance. A meta-analysis of case-control studies reporting the odds ratios (ORs) of AVN among HIV-infected patients who were exposed to PIs compared with non-exposed patients was conducted. Pooled ORs and 95% confidence intervals (CIs) were calculated using a fixed-effect Mantel-Haenszel analysis. Four case-control studies were identified and included for data analysis. The meta-analysis demonstrated an increased odds of AVN in participants exposed to PIs, with an OR of 2.09 (95% CI 1.01-4.31; P=0.05). The statistical heterogeneity of this meta-analysis was determined not to be important, with an I(2) of 0%. The meta-analysis revealed a statistically significant increased odds of AVN among PI-exposed, HIV-infected patients. Physician should be aware of this association as it may help guide potential therapeutic options, particularly for patients with other classic risk factors for AVN.
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY 13326, USA.
authors.forename: Nitipong
authors.initials: N
authors.lastname: Permpalung
authors.affiliation: Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok 10700, Thailand. Electronic address: Patompong.Ungprasert@bassett.org.
authors.forename: Patompong
authors.initials: P
authors.lastname: Ungprasert
authors.affiliation: Department of Internal Medicine, Queens Hospital Center, Jamaica, New York, NY 11432, USA.
authors.forename: Sarawut
authors.initials: S
authors.lastname: Summachiwakij
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY 13326, USA.
authors.forename: Napat
authors.initials: N
authors.lastname: Leeaphorn
authors.affiliation: Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, Cooperstown, NY 13326, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Knight
mesh_terms: D016022:Case-Control Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology*
chemical_list: D017320:HIV Protease Inhibitors
keywords: Avascular necrosis; HIV infection; Osteonecrosis; Protease inhibitor