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Osteopaenia and Osteonecrosis in HIV Infection: Report of Two Cases
Abstract
The introduction in the mid 1990’s of highly active anti-retroviral drugs therapy (HAART) in the treatment of human immunodeficiency virus (HIV) infection has significantly changed the course, manifestation of HIV disease and improved the life expectancy of HIV infected patients.
The consequence of longer survival has manifested increasing rates of co-morbid diseases and aroused interest in the interaction of HIV and aging The pathogenesis of the resultant conditions though not fully understood is likely multifactorial and may be related to direct effect of the HIV virus and associated immunodeficiency, underlying opportunistic events, immunoactivation ,related vasculopathies and inflammatory processes and toxic effects of anti-retroviral agents Bone disorders as such osteopaenia, osteoporosis and bone fractures, osteonecrosis and accompanying metabolic changes, has been reported with increasing frequency. We report two cases of patients known to be HIV positive and on HAART who presented with hip pain. The first patient had radiological evidence of osteonecrosis (avascular necrosis) of the head of femur, and second patient who presented with acute sudden onset pain had fracture of the neck of femur. Literature is reviewed to elucidate possible mechanism of disease and a brief consideration of possible therapy is discussed.
The consequence of longer survival has manifested increasing rates of co-morbid diseases and aroused interest in the interaction of HIV and aging The pathogenesis of the resultant conditions though not fully understood is likely multifactorial and may be related to direct effect of the HIV virus and associated immunodeficiency, underlying opportunistic events, immunoactivation ,related vasculopathies and inflammatory processes and toxic effects of anti-retroviral agents Bone disorders as such osteopaenia, osteoporosis and bone fractures, osteonecrosis and accompanying metabolic changes, has been reported with increasing frequency. We report two cases of patients known to be HIV positive and on HAART who presented with hip pain. The first patient had radiological evidence of osteonecrosis (avascular necrosis) of the head of femur, and second patient who presented with acute sudden onset pain had fracture of the neck of femur. Literature is reviewed to elucidate possible mechanism of disease and a brief consideration of possible therapy is discussed.
