SCRIBNER AN, SKIEST DJ, MARCANTONIO D, HAMID F, TROIA-CANCIO PV, KEISER P; Interscience Conference on Antimicrobial Agents and Chemotherapy.

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1999 Sep 26-29; 39: 503 (abstract no. 1311).

Univ. of Texas Southwest Med. Ctr., Dallas, TX.

BACKGROUND: Forty-two cases of osteonecrosis (ON) in HIV-infected patients have been reported. It has been suggested that HIV and treatment with protease inhibitors (PIs) are independent risk factors for ON.METHODS: We identified 16 cases of ON from 1984 to 1998 from a large county HIV clinic (~3500 patients in 1998). Imaging studies were independently reviewed by a radiologist. A retrospective chart review was performed to evaluate potential risk factors for ON. Cases were matched with 2 controls for HIV positivity and date of diagnosis.RESULTS: The incidence of osteonecrosis in our HIV clinic population was 0.29% in 1998. ON risk factors in the cases included alcoholism (31%), corticosteroids (18%), hypercoaguability (12%), gout (6%), probably Cushings disease (6%), and osteopenia (6%). Twenty-five percent of the cases were idiopathic. The only risk factor for ON found in controls was alcoholism (23%). The mean age of cases was 39 vs 37 for controls. All cases were male whereas 15% of controls were female. Multiple joints were involved in 75% of cases, predominately bilateral hips but 18% had shoulder involvement also. HIV risk factors were analyzed and 87% had a history of male to male sex, 25% had a history of intravenous drug use (IVDU), and 6% had no risk factor documented. In controls, 46% had a history of male to male sex, 19% IVDU, 12% were heterosexual transmission and 27% had no documented risk factor. No significant differences were found between cases and controls with respect to liver function tests, testosterone levels, triglyceride levels or CD4 counts (261 in cases vs 292 in controls, p>0.05). No differences in PI usage among cases and controls were noted: 77% vs 73% respectively.CONCLUSIONS: The incidence of osteonecrosis in our HIV/AIDS clinic population is ~58 fold greater than expected in the general population; however, the proportion of idiopathic cases is approximately that expected in the general population. The increased incidence of ON in HIV/AIDS may be due to an increased frequency of risk factors previously associated with osteonecrosis such as corticosteroid use, alcohol abuse, other thrombotic events, disorders of lipid metabolism, and osteopenia compared to the general HIV negative population.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• CD4 Lymphocyte Count
• Case-Control Studies
• Female
• HIV Infections
• HIV Seropositivity
• Humans
• Incidence
• Male
• Osteonecrosis
• Risk Factors
• Substance Abuse, Intravenous

Other ID:

• GWAIDS0008208

UI: 102245705

From Meeting Abstracts