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Ann Intern Med. 2002 Jul 2;137(1):17-25.

High prevalence of osteonecrosis of the femoral head in HIV-infected adults.

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  • 1Critical Care Medicine Department, Clinical Center, Building 10, Room 7D43, MSC1662, National Institutes of Health, Bethesda, MD 20892-1662, USA.

Abstract

BACKGROUND:

Osteonecrosis has been reported to occur occasionally among HIV-infected patients. The diagnosis of symptomatic osteonecrosis of the hip in two of the authors' patients, together with reports from community physicians, raised a concern that the prevalence of osteonecrosis is increasing.

OBJECTIVE:

To determine the prevalence of osteonecrosis of the hip in asymptomatic HIV-infected patients and to identify potential risk factors associated with osteonecrosis.

DESIGN:

Survey and comparison study.

SETTING:

The Clinical Center of the U.S. National Institutes of Health.

PARTICIPANTS:

339 asymptomatic HIV-infected adults (of 364 asked to participate) and 118 age- and sex-matched HIV-negative volunteers enrolled between 1 June and 15 December 1999.

MEASUREMENTS:

Osteonecrosis of the hip, as documented by magnetic resonance imaging. Data from clinic records and a patient questionnaire administered before magnetic resonance imaging were used in an analysis of risk factors. A subset of patients was evaluated for hypercoagulable state.

RESULTS:

Fifteen (4.4% [95% CI, 2.5% to 7.2%]) of 339 HIV-infected participants had osteonecrosis lesions on magnetic resonance imaging, and no HIV-negative participants had similar lesions. Among HIV-infected participants, osteonecrosis occurred more frequently in those who used systemic corticosteroids, lipid-lowering agents, or testosterone; those who exercised routinely by bodybuilding; and those who had detectable levels of anticardiolipin antibodies.

CONCLUSIONS:

Patients infected with HIV have an unexpectedly high occurrence of osteonecrosis of the hip. Although screening asymptomatic patients is not warranted, HIV-infected patients with persistent groin or hip pain should be evaluated for this debilitating complication.

PMID:
12093241
[PubMed - indexed for MEDLINE]
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