Osteonecrosis in HIV

A case-control study

Anita N. Scribner, Paolo Troia-Cancio, Bruce A. Cox, David Marcantonio, Faruk Hamid, Philip Keiser, Marilyn Levi, Brady Allen, Kevin Murphy, Richard E. Jones, Daniel J. Skiest

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Background: Osteonecrosis (avascular necrosis) has been infrequently reported in HIV-infected patients. It is not known whether HIV itself is an independent risk factor for osteonecrosis. Methods: We identified 25 patients with osteonecrosis from 1984 to 1999 from a large county teaching hospital and two large practices in Dallas County that specialize in HIV-disease related therapy. A retrospective chart review was performed to evaluate potential risk factors for osteonecrosis. Each case was matched with two controls for HIV positive status and date of osteonecrosis diagnosis. Results: In the study, 22 of 25 (88%) case patients had at least one osteonecrosis risk factor compared with 24 of 50 (48%) controls, p = .003. The most common osteonecrosis risk factors were hyperlipidemia (32%), alcoholism (28%), pancreatitis (16%), corticosteroids (12%), and hypercoaguability (12%). Of the cases, 12% were idiopathic. Multiple joints were involved in 72% of cases. Four of the case patients compared with none of the controls received megesterol acetate before the diagnosis of osteonecrosis, p = .01. No significant differences were found between cases and controls with respect to liver function tests, testosterone levels, triglyceride levels, cholesterol levels, or CD4 cell counts. Saquinavir was independently associated with osteonecrosis, p < .05. However, no differences in overall use of protease inhibitors among cases and controls were noted: 79% versus 76%, respectively. Conclusions: The increased incidence of osteonecrosis in HIV/AIDS may be due to an increased frequency of risk factors previously associated with osteonecrosis such as hyperlipidemia, corticosteroid use, alcohol abuse, and hypercoaguability. Use of protease inhibitors was not independently associated with osteonecrosis.

Original languageEnglish (US)
Pages (from-to)19-25
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume25
Issue number1
DOIs
StatePublished - Sep 1 2000
Externally publishedYes

Fingerprint

Osteonecrosis
Case-Control Studies
HIV
Hyperlipidemias
Protease Inhibitors
Alcoholism
Adrenal Cortex Hormones
Saquinavir
County Hospitals
Liver Function Tests
CD4 Lymphocyte Count
Teaching Hospitals
Pancreatitis
Testosterone
Acquired Immunodeficiency Syndrome
Triglycerides
Acetates
Necrosis
Joints
Cholesterol

Keywords

  • AIDS
  • Avascular necrosis
  • HIV
  • Osteonecrosis
  • Protease inhibitors

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Scribner, A. N., Troia-Cancio, P., Cox, B. A., Marcantonio, D., Hamid, F., Keiser, P., ... Skiest, D. J. (2000). Osteonecrosis in HIV: A case-control study. Journal of Acquired Immune Deficiency Syndromes, 25(1), 19-25. https://doi.org/10.1097/00126334-200009010-00003

Osteonecrosis in HIV : A case-control study. / Scribner, Anita N.; Troia-Cancio, Paolo; Cox, Bruce A.; Marcantonio, David; Hamid, Faruk; Keiser, Philip; Levi, Marilyn; Allen, Brady; Murphy, Kevin; Jones, Richard E.; Skiest, Daniel J.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 25, No. 1, 01.09.2000, p. 19-25.

Research output: Contribution to journalArticle

Scribner, AN, Troia-Cancio, P, Cox, BA, Marcantonio, D, Hamid, F, Keiser, P, Levi, M, Allen, B, Murphy, K, Jones, RE & Skiest, DJ 2000, 'Osteonecrosis in HIV: A case-control study', Journal of Acquired Immune Deficiency Syndromes, vol. 25, no. 1, pp. 19-25. https://doi.org/10.1097/00126334-200009010-00003
Scribner, Anita N. ; Troia-Cancio, Paolo ; Cox, Bruce A. ; Marcantonio, David ; Hamid, Faruk ; Keiser, Philip ; Levi, Marilyn ; Allen, Brady ; Murphy, Kevin ; Jones, Richard E. ; Skiest, Daniel J. / Osteonecrosis in HIV : A case-control study. In: Journal of Acquired Immune Deficiency Syndromes. 2000 ; Vol. 25, No. 1. pp. 19-25.
@article{6dee8eee19214d43b4070c88703d817c,
title = "Osteonecrosis in HIV: A case-control study",
abstract = "Background: Osteonecrosis (avascular necrosis) has been infrequently reported in HIV-infected patients. It is not known whether HIV itself is an independent risk factor for osteonecrosis. Methods: We identified 25 patients with osteonecrosis from 1984 to 1999 from a large county teaching hospital and two large practices in Dallas County that specialize in HIV-disease related therapy. A retrospective chart review was performed to evaluate potential risk factors for osteonecrosis. Each case was matched with two controls for HIV positive status and date of osteonecrosis diagnosis. Results: In the study, 22 of 25 (88{\%}) case patients had at least one osteonecrosis risk factor compared with 24 of 50 (48{\%}) controls, p = .003. The most common osteonecrosis risk factors were hyperlipidemia (32{\%}), alcoholism (28{\%}), pancreatitis (16{\%}), corticosteroids (12{\%}), and hypercoaguability (12{\%}). Of the cases, 12{\%} were idiopathic. Multiple joints were involved in 72{\%} of cases. Four of the case patients compared with none of the controls received megesterol acetate before the diagnosis of osteonecrosis, p = .01. No significant differences were found between cases and controls with respect to liver function tests, testosterone levels, triglyceride levels, cholesterol levels, or CD4 cell counts. Saquinavir was independently associated with osteonecrosis, p < .05. However, no differences in overall use of protease inhibitors among cases and controls were noted: 79{\%} versus 76{\%}, respectively. Conclusions: The increased incidence of osteonecrosis in HIV/AIDS may be due to an increased frequency of risk factors previously associated with osteonecrosis such as hyperlipidemia, corticosteroid use, alcohol abuse, and hypercoaguability. Use of protease inhibitors was not independently associated with osteonecrosis.",
keywords = "AIDS, Avascular necrosis, HIV, Osteonecrosis, Protease inhibitors",
author = "Scribner, {Anita N.} and Paolo Troia-Cancio and Cox, {Bruce A.} and David Marcantonio and Faruk Hamid and Philip Keiser and Marilyn Levi and Brady Allen and Kevin Murphy and Jones, {Richard E.} and Skiest, {Daniel J.}",
year = "2000",
month = "9",
day = "1",
doi = "10.1097/00126334-200009010-00003",
language = "English (US)",
volume = "25",
pages = "19--25",
journal = "Journal of acquired immune deficiency syndromes (1999)",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Osteonecrosis in HIV

T2 - A case-control study

AU - Scribner, Anita N.

AU - Troia-Cancio, Paolo

AU - Cox, Bruce A.

AU - Marcantonio, David

AU - Hamid, Faruk

AU - Keiser, Philip

AU - Levi, Marilyn

AU - Allen, Brady

AU - Murphy, Kevin

AU - Jones, Richard E.

AU - Skiest, Daniel J.

PY - 2000/9/1

Y1 - 2000/9/1

N2 - Background: Osteonecrosis (avascular necrosis) has been infrequently reported in HIV-infected patients. It is not known whether HIV itself is an independent risk factor for osteonecrosis. Methods: We identified 25 patients with osteonecrosis from 1984 to 1999 from a large county teaching hospital and two large practices in Dallas County that specialize in HIV-disease related therapy. A retrospective chart review was performed to evaluate potential risk factors for osteonecrosis. Each case was matched with two controls for HIV positive status and date of osteonecrosis diagnosis. Results: In the study, 22 of 25 (88%) case patients had at least one osteonecrosis risk factor compared with 24 of 50 (48%) controls, p = .003. The most common osteonecrosis risk factors were hyperlipidemia (32%), alcoholism (28%), pancreatitis (16%), corticosteroids (12%), and hypercoaguability (12%). Of the cases, 12% were idiopathic. Multiple joints were involved in 72% of cases. Four of the case patients compared with none of the controls received megesterol acetate before the diagnosis of osteonecrosis, p = .01. No significant differences were found between cases and controls with respect to liver function tests, testosterone levels, triglyceride levels, cholesterol levels, or CD4 cell counts. Saquinavir was independently associated with osteonecrosis, p < .05. However, no differences in overall use of protease inhibitors among cases and controls were noted: 79% versus 76%, respectively. Conclusions: The increased incidence of osteonecrosis in HIV/AIDS may be due to an increased frequency of risk factors previously associated with osteonecrosis such as hyperlipidemia, corticosteroid use, alcohol abuse, and hypercoaguability. Use of protease inhibitors was not independently associated with osteonecrosis.

AB - Background: Osteonecrosis (avascular necrosis) has been infrequently reported in HIV-infected patients. It is not known whether HIV itself is an independent risk factor for osteonecrosis. Methods: We identified 25 patients with osteonecrosis from 1984 to 1999 from a large county teaching hospital and two large practices in Dallas County that specialize in HIV-disease related therapy. A retrospective chart review was performed to evaluate potential risk factors for osteonecrosis. Each case was matched with two controls for HIV positive status and date of osteonecrosis diagnosis. Results: In the study, 22 of 25 (88%) case patients had at least one osteonecrosis risk factor compared with 24 of 50 (48%) controls, p = .003. The most common osteonecrosis risk factors were hyperlipidemia (32%), alcoholism (28%), pancreatitis (16%), corticosteroids (12%), and hypercoaguability (12%). Of the cases, 12% were idiopathic. Multiple joints were involved in 72% of cases. Four of the case patients compared with none of the controls received megesterol acetate before the diagnosis of osteonecrosis, p = .01. No significant differences were found between cases and controls with respect to liver function tests, testosterone levels, triglyceride levels, cholesterol levels, or CD4 cell counts. Saquinavir was independently associated with osteonecrosis, p < .05. However, no differences in overall use of protease inhibitors among cases and controls were noted: 79% versus 76%, respectively. Conclusions: The increased incidence of osteonecrosis in HIV/AIDS may be due to an increased frequency of risk factors previously associated with osteonecrosis such as hyperlipidemia, corticosteroid use, alcohol abuse, and hypercoaguability. Use of protease inhibitors was not independently associated with osteonecrosis.

KW - AIDS

KW - Avascular necrosis

KW - HIV

KW - Osteonecrosis

KW - Protease inhibitors

UR - http://www.scopus.com/inward/record.url?scp=0034273758&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034273758&partnerID=8YFLogxK

U2 - 10.1097/00126334-200009010-00003

DO - 10.1097/00126334-200009010-00003

M3 - Article

VL - 25

SP - 19

EP - 25

JO - Journal of acquired immune deficiency syndromes (1999)

JF - Journal of acquired immune deficiency syndromes (1999)

SN - 1525-4135

IS - 1

ER -