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1 March 2007

Volume 44, Number 5
Clinical Infectious Diseases 2007;44:739–748
This article is in the public domain, and no copyright is claimed.
1058-4838/2007/4405-0020
DOI: 10.1086/511683
HIV/AIDS MAJOR ARTICLE

The Incidence and Natural History of Osteonecrosis in HIV‐Infected Adults

Caryn G. Morse,2

JoAnn M. Mican,1

Elizabeth C. Jones,3

Galen O. Joe,4

Margaret E. Rick,5

Elizabeth Formentini,2 and

Joseph A. Kovacs2

1Office of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), and 2Critical Care Medicine Department and Departments of 3Radiology, 4Rehabilitation Medicine, and 5Laboratory Medicine, NIH Clinical Center, Bethesda, Maryland

Background.Osteonecrosis is increasingly recognized as a debilitating complication of human immunodeficiency virus (HIV) infection, but the natural history has not been well described. We previously documented a high prevalence (4.4%) of magnetic resonance imaging (MRI)–documented osteonecrosis of the hip in a cohort of 339 asymptomatic HIV‐infected patients. The present study was designed to determine the incidence of newly diagnosed osteonecrosis in this cohort and to describe the natural history of osteonecrosis in HIV‐infected patients.

Methods.Asymptomatic HIV‐infected patients with a previous hip MRI negative for osteonecrosis underwent follow‐up MRI. Patients with asymptomatic or symptomatic osteonecrosis were enrolled in a natural history study, which included serial MRIs and a physiotherapy follow‐up.

Results.Two hundred thirty‐nine patients underwent a second MRI a median of 23 months after the initial MRI. Osteonecrosis of the femoral head was diagnosed in 3 patients (incidence, 0.65 cases per 100 person‐years). During the period of January 1999 through April 2006, symptomatic hip osteonecrosis developed in 13 clinic patients (incidence, 0.26 cases per 100 person‐years). Among 22 patients enrolled with symptomatic hip osteonecrosis, 18 had bilateral involvement of the femoral heads, and 7 had osteonecrosis involving other bones. Two (11%) of 18 asymptomatic patients and 13 (59%) of 22 symptomatic patients underwent total hip replacement. The percentage of involvement of the weight‐bearing surface of the femoral head and the rate of progression to total hip replacement was significantly greater ( ) in symptomatic patients than in asymptomatic patients.

Conclusions.HIV‐infected patients are at 100‐fold greater risk of developing osteonecrosis than the general population. Disease progression is slower in asymptomatic patients than in symptomatic patients. Given the high frequency of total hip replacement in symptomatic patients, studies to assess preventive and treatment strategies are essential.

Received 16 August 2006; accepted 13 November 2006; electronically published 23 January 2007.

Reprints or correspondence: Dr. Caryn G. Morse, National Institutes of Health, 9000 Rockville Pike, Bldg. 10, Rm. 2C145, MSC 1662, Bethesda, MD 20892‐1662 ().

Cited by

Jean-Cyr Yombi, Bernard Vandercam, Dunja Wilmes, Jean-Emile Dubuc, Anne Vincent, Pierre-Louis Docquier. (2009) Osteonecrosis of the femoral head in patients with type 1 human immunodeficiency virus infection: clinical analysis and review. Clinical Rheumatology 28:7, 815-823
Online publication date: 1-Aug-2009.
CrossRef
David R. Marker, Thorsten M. Seyler, Slif D. Ulrich, Siddharth Srivastava, Michael A. Mont. (2008) Do Modern Techniques Improve Core Decompression Outcomes for Hip Osteonecrosis?. Clinical Orthopaedics and Related Research 466:5, 1093-1103
Online publication date: 1-Jun-2008.
CrossRef
Thorsten M. Seyler, David R. Marker, Slif D. Ulrich, Tobias Fatscher, Michael A. Mont. (2008) Nonvascularized Bone Grafting Defers Joint Arthroplasty in Hip Osteonecrosis. Clinical Orthopaedics and Related Research 466:5, 1125-1132
Online publication date: 1-Jun-2008.
CrossRef
U. A. Walker, A. Tyndall, T. Daikeler. (2008) Rheumatic conditions in human immunodeficiency virus infection. Rheumatology 47:7, 952-959
Online publication date: 25-May-2008.
CrossRef
Worawit Louthrenoo. (2008) Rheumatic manifestations of human immunodeficiency virus infection. Current Opinion in Rheumatology 20:1, 92-99
Online publication date: 1-Feb-2008.
CrossRef

  • Presented in part: 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, Dublin, Ireland, 13–17 November 2005 (abstract 86).

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