Several reports have described an increased incidence of osteonecrosis in human immunodeficiency virus—infected patients (HIV+), but the cause has not been established. The association between thrombophilia and osteonecrosis in HIV+ was studied. A case-control study in HIV+, 19 cases and 38 controls, was designed. Magnetic resonance imaging was made in both groups to confirm or exclude hip osteonecrosis. The extensive tests of thrombophilia were measured, and the clinical data were recorded, nadir of CD4+ cell count and well-known risk factors for osteonecrosis. Thrombophilia has been frequently found both in patients with and without osteonecrosis (thrombophilia, 68.4% vs 60.5%), but no specific thrombophilia tests were significantly associated with osteonecrosis. A low nadir of CD4+ (<60 cells/μL) and corticoid use were significantly (P < .05) associated with osteonecrosis. In multivariate analysis, only nadir of CD4+ <60 cells/μL remained a predictor of osteonecrosis (odds ratio = 7.33; 95% confidence interval, 1.80-29.82, P = .005). Thrombophilia might have a limited role in the development of osteonecrosis in HIV+. Nadir of CD4+ <60 cells/μL and corticoid use were main factors.
Hungerford DS , Jones LCAsymptomatic osteonecrosis. Should be treated ? Clin Orthop. 2004;429:124-130.
3.
Cherian SF, Laorr A., Saleh KJ, et al. Quantifying the extent of femoral head involvement in osteonecrosis . J Bone Joint Surg Am. 2003;85:309-315.
4.
Koller E., Mann M., Malozowski S., et al. Aseptic necrosis in HIV seropositive patients: a possible etiologic role for megestrol acetate. AIDS Patient Care STDs. 2000; 14: 405-410.
Glueck CJ, Freiberg RA, Wang P.Role of thrombosis in osteonecrosis. Current Hematol Rep. 2003;2:417-422.
7.
Keruly JC, Chaisson RE, Moore RDIncreasing incidence of avascular necrosis of the hip in HIV-infected patients . J Acquir Immune Defic Syndr. 2001 ;28:101-102.
8.
Brown P., Crane L.Avascular necrosis of bone in patients with human immunodeficiency virus infection: review of the literature. Clin Infect Dis . 2001;32:1221-1226.
9.
Miller KD, Masur H., Jones EC, et al. High prevalence of osteonecrosis of the femoral head in HIV-infected adults. Ann Intern Med. 2002;137:17-24.
10.
Gaughan DM, Mofenson LM, Hughes MD, et al. Osteonecrosis of the hip (Legg-Calvé-Perthes Disease) in human immunodeficiency virus-infected children. Pediatrics. 2002;109:E74.
11.
Thomas J., Doherty SMHIV infection: a risk factor for osteoporosis. J Acquir Immune Defic Syndr. 2003;33: 281-291.
12.
Hasse B., Ledergerber B., Egger M., et al. Antiretroviral treatment and osteonecrosis in patients of the Swiss HIV cohort study: a nested case-control study. AIDS Res Hum Retroviruses. 2004;20:909-915.
13.
Molia AC, Strady C., Rouger C., et al. Osteonecrosis in six HIV-Infected patients receiving highly active antiretroviral therapy. Ann Phamacother. 2004;38:2050-2054.
14.
Calza L., Manfredi R., Mastroianni A., et al. Osteonecrosis and highly active antiretroviral therapy during HIV infection: report of a series and literature review. AIDS Patient Care STDs. 2001;15:385-389.
15.
Bottaro E., Figueroa RH, Scapellato P., et al. Osteonecrosis en pacientes infectados por HIV. Medicina. 2004;64: 325-331.
16.
Scribner AN , Trota-Cancio PV, Cox BA, et al. Osteonecrosis in HIV: a case-control study. J Acquir Immune Defic Syndr . 2000;25:19-25.
17.
Gutiérrez F. , Padilla S., Ortega E., et al. Avascular necrosis of the bone in HIV-infected patients: incidence and associated factors. J Acquir Immune Defic Syndr. 2002; 16:481-495.
18.
Mahoney CR, Glesby MJ, DiCarlo EF, et al. Total hip arthroplasty in patients with human immunodeficiency virus infection. Acta Orthop. 2005;76:198-203.
19.
Panayotakopoulos GD, Day S., Peters BS, et al. Severe osteoporosis and multiple fractures in an AIDS patient treated with short-term steroids for lymphoma: a need for guidelines. Int J STD AIDS. 2006;17:567-568.
20.
Amorosa V., Tebas P.Bone disease and HIV infection. Clin Infect Dis. 2006;42:108-114.
21.
de Larrañaga G., Forastiero R., Carreras LO, et al. Different types of antiphospholipid antibodies in AIDS. A comparison with syphilis and the antiphospholipid syndrome . Thromb Res.1999 ;96:19-25.
22.
Jones LC, Mont MA, Le TB, et al. Procoagulants and osteonecrosis. J Rheumatol . 2003;30:783-791.
23.
de Larrañaga G., Perés S., Puga L., et al. Association between the acquired free protein S deficiency in HIV-infected patients with the lipid profile levels . J Thromb Haemost. 2004;2:1195-1197.
24.
Cervera R., Asherson RA, Acevedo ML, et al. Antiphospholipid syndrome associated with infections: clinical and microbiological characteristics of 100 patients. Ann Rheum Dis. 2004;63:1312-1317.
25.
de Larrañaga G., Galich A., Puga L., et al. Insulin resistance status is an important determinant of PAI-1 levels in HIV infected patients, independently of the lipid profile. J Thromb Haemost. 2004;2:532-534.
26.
de Larrañaga G., Bocassi A., Puga L., et al. Endothelial markers and HIV infection in the era of highly active antiretroviral treatment . Thromb Res. 2003;110:93-98.
27.
Vasoo S., Sangle S., Zain M., et al. Orthopedic manifestation of the antiphospholipid (Hughes) syndrome . Lupus. 2005;14:339-345.
28.
Tektonidou MG, Malagari K., Vlachoyiannopoulos PG, et al. Asymptomatic avascular necrosis in patients with primary antiphospholipid syndrome in the absence of corticosteroid use. Arthritis Rheum. 2003;48:732-736.
29.
Ramos-Casals M., Cervera R., Lagrutta M., et al. Clinical feature related to antiphospholipid syndrome in patients with chronic viral infections (Hepatitis C virus/HIV infection): description of 82 cases. Clin Infect Dis.2004;38:1009-1016.
30.
Miyakis S., Lockshin MD, Atsumi T., et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295-306.
31.
Calder JDF , Buttery L., Revell PA, et al. Apoptosis-a significant cause of bone cell death in osteonecrosis of the femoral head. J Bone Joint Surg Br. 2004:86: 1209-1213.
32.
Nagasawa K. , Tada Y., Koarada S., et al. Very early development of steroid-associated osteonecrosis of the femoral head in systemic lupus erythematosus: prospective study by MRI. Lupus. 2005;14:385-390.
33.
Ichiseki T. , Kaneuji A., Katsuda S., et al. DNA oxidation injury in bone early after steroid administration is involved in the pathogenesis of steroid-induced osteonecrosis. Rheumatology. 2005;44:456-460.
34.
Kabata T., Kubo T., Matsumoto T., et al. Onset of steroid-induced osteonecrosis in rabbits an dits relationship to hyperlipaemia and increased free fatty acids. Rheumatology . 2005;44:1233-1237.
35.
Motomura G. , Yamamoto T., Miyanishi K., et al. Combined effects of an anticoagulant and a lipid-lowering agent on the prevention of steroid-induced osteonecrosis in rabbits. Arthritis Rheum. 2004;50:3387-3391.
36.
Gutierrez F. , Padilla S., Masiá M., et al. Osteonecrosis in patients infected with HIV: clinical epidemiology and natural history in a large case series from Spain. J Acquir Immune Defic Syndr . 2006 ;42:286-292.
37.
Mary-Krause M., Billaud E., Poizot-Martin I., et al. Clinical Epidemiology Group of the French Hospital Database.Risk factor for osteonecrosis in HIV-infected patients: impact of treatment with combination antiretroviral therapy. AIDS. 2006;20:1627-1635.
38.
Lawson-Ayayi S., Bonnet F., Bernardin E., et al. Avascular necrosis in HIV-infected patients: a case-control study from the Aquitaine cohort, 1997-2002, France . Clin Infect Dis.2005;40:1188-1193.
39.
Skiest DJOsteonecrosis in human immunodeficiency virus-infected patients may not be related to immune reconstitution. Clin Infect Dis. 2001;33: 268-270.
40.
Tektonidou MG, Moutsopoulos HMImmunologic factors in the pathogenesis of osteonecrosis. Orthop Clin N Am. 2004;35:259-263.
