Background/Purpose:

Infection with the HIV has been associated with an increased risk of developing avascular necrosis (AVN), however there are only few studies in the US that analyzed the frequency and risk factors of the AVN in HIV patients on antiretroviral therapy (ART). The aim of this study was to determine the prevalence of AVN in well-controlled HIV-infected patients who were receiving antiretroviral treatment and evaluate potential risks factors including HIV medications.

Methods:

: A retrospective review of our medical record database over a 6 year period was conducted using ICD-9 and ICD-10 codes. Three thousand patients with chronic HIV infection on ART that had more than 2 visits in the HIV clinic were identified. Individual electronic patient charts were reviewed and we identified patients diagnosed with AVN that was confirmed by magnetic resonance imaging studies. We collected data regarding patient’s demographic characteristics, co-morbidities, T-helper lymphocytes with CD4 cell surface marker count, HIV RNA viral load and antiretroviral regimen. Two hundred randomly selected HIV-infected patients on ART without a diagnosis of AVN were used as a control group. Group differences were statistically compared and presented using Mann-Whitney U and Fisher’s exact test.

Results:

Forty two out of 3000 HIV patients (1.4 %) with AVN were identified (mean age of 49.5 years, 87% male). The most commonly involved joint was the hip (80%, n=34), followed by the glenohumeral (7.5%, n=4), femoral condyle (4.7%, n=2) and ankle (4.7%, n=2). Associated co-morbidities in patients with AVN included hyperlipidemia (21%, n=9), hypertension (19%, n=8), COPD/asthma(12%,n=5), hepatitis C (12%,n=5). All the patients with COPD/asthma have been treated with corticosteroids. Ten patients underwent joint replacement (23%), 4 core decompression surgery (9%) and the rest non-operative management.

Compared with the 200 HIV control patients, the patients with AVN were older (mean age of 49.5 vs. 42.7 years; p<0.01), had a history of COPD treated with corticosteroids (p= 0.02) and had a longer duration of HIV infection (mean duration of 16.8 vs.10.3 years; p<0.01). Patients who developed AVN were more likely to be receiving integrase strand transfer inhibitors (66%) compare to those who never received integrase inhibitors (20%; p<0.01). No differences were found between ANV patients and controls with respect to CD4 cell counts or viral load

Conclusion:

AVN remains one of the most frequent musculoskeletal complication in HIV patients. Potential risk factors associated with the development of AVN in HIV patients were older age, longer duration of HIV infection, history of COPD/asthma, corticosteroid use and the use of ART regimens containing integrase strand transfer inhibitors.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hiv-infection-and-avascular-necrosis-in-the-antiretroviral-era/