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THU0227 Osteonecrosis (on) in hiv infection patients: 21affected joints in 9 patients
  1. M Larrosa1,
  2. M Cervantes2,
  3. J Gratacós1,
  4. M Sala2,
  5. R Valls3,
  6. G Gili4
  1. 1Rheumatology Unit
  2. 2Internal Medicine
  3. 3Radiology
  4. 4Traumatology, University Hospital C. S. P. T., Sabadell, Spain

Abstract

Background ON has been described in the setting of HIV infection. No epidemiological studies are available but their incidence seems to be increased and associated to the protease inhibitor (PI) into highly active antiretroviral therapy (HAART).

Objectives To report the clinical findings of 9 HIV infected patients with ON.

Methods Nine patients (8M/1W), mean age 40.7 (36–49 years). Review of clinical, biological and radiological characteristics.

Results All cases were seen after 1998 and 8/9 received PI. In all cases the antiretroviral treatment was successfully (undetectable viral copies: < 200 copies/ml). The diagnosis of the ON was made at 125 days (15–634) after the beginning of symptoms. 3/9 patients showed unilateral hip ON, 3/9 bilateral hip ON and 3/9 bilateral hip and shoulder ON.13/21 ON joints were demonstrated by radiology and 8/21 by IMR. 13/21 joints presented mechanical pain, 4/21 inflammatory pain and 4/21 were silent. Forage was performed in 4/21 and hip arthroplasty in 2/21. 6/9 patients presented hyperlipidaemia (6 hypercholesterolaemia, 4 hypertriglyceridaemia), 8/9 insulin resistance, 4/9 coagulation disturbances (4 deficits of C and S protein, 1 antiphospholipid antibodies), 7/9 haemoglobin >16 g/dl and 5/9 had received steroid therapy.

Conclusion The ON seems to be a new complication associated to the HIV infection. The ON presented frequently as a polyarticular involvement disease. In most cases its presence is associated with several risk factors, and probably the HAART is one of them.

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