10th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 6-8 November 2008, London, UK

ASYMPTOMATIC OSTEONECROSIS OF THE HIP IN HIV-INFECTED PATIENTS

Antiviral Therapy 2008; 13(Suppl. 4):A34 (abstract no. P-16)

JL Lamas¹, A Ocampo¹, C Miralles¹, R Longueira¹, MT Pérez¹, A Casal², J Corroto², M Arias², B Sopeña¹, A Rivera¹ and C Martínez Vázquez^1
1Servicio de Medicina Interna, Hospital Xeral, Complejo Hospitalario Universitario de Vigo, Vigo (Pontevedra), España; ²Servicio de radiodiagnóstico, Hospital Xeral, Complejo Hospitalario Universitario de Vigo, Vigo (Pontevedra), España

BACKGROUND: Osteonecrosis of the hip (OTNH) in HIV-infected patients has been related to corticosteroids, dyslipidaemia, alcoholism, lipodystrophy and the HIV infection itself. Some cases of OTNH have been also related to antiretroviral drugs (ARV). The aim of this study was to evaluate the prevalence of silent OTNH in HIV-infected patients and its association with risk factors.

METHODS: Adults outpatients (<70-years-old) with HIV infection diagnosis before January 2006 were prospectively evaluated between March and May 2008. Patients diagnosed with OTNH and those with current symptoms were excluded. A magnetic resonance study (MR) of the hips was performed. According to ARV treatment, patients were classified group I: patients without previous ARV treatment; group II: those who have received only one scheme of ARV treatment; and group III: patients with multiple ARV treatments.

RESULTS: MR was performed in 97 white patients (group I: 23, group II: 24 and group III: 50), 68 were men with a mean age of 44.8 years (range 24–67). OTNH was detected in four patients (4.1%), two of them were bilateral. The four patients with OTNH were males, with a mean age of 46 years (range: 40–55). The mean time of HIV infection was 13 years (range 5–21 years). The current average of total CD4 lymphocyte count was 506 cells/µl (range 205–807) and the mean CD4 lymphocyte nadir was 27 cells/µl (range 12–43). All the patients except one have undetectable levels of HIV viral load (<40 copies/ml). Three patients were in group III and the other in group II. The mean duration of the ARV treatment was 11 years (range: 5–15). Multiple risk factors for OTNH were recorded in every patient: three with lipodystrophy, three with corticosteroids therapy, two with hypertrigliceridaemia, two with alcoholism and one with pancreatitis. CD4 lymphocyte nadir (P=0.034), proportion of patients with CDC stage C (P=0.039) and patients with previous treatment with corticosteroids (P=0.042) were significantly different between patients with OTNH and those with normal MR.

CONCLUSIONS: The prevalence of asymptomatic OTNH in HIV-infected patients was 4.1%. The most important risk factors for OTNH were corticosteroid treatment, a lower CD4 lymphocyte nadir and AIDS-defining disease. In this group of patients, ARV treatment was not associated with the presence of osteonecrosis.

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2008-11-06
P-16

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