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HIV-positive Individuals Have a Massively Increased Risk of Osteonecrosis

People with HIV have approximately a hundred times greater risk of developing osteonecrosis (bone death) than the general population,// researchers at the US National Institutes of Health have found. The findings were published in the March 1st online edition of Clinical Infectious Diseases.

Incidence

Osteonecrosis or ‘bone death’ occurs when the blood supply to the bone is disrupted, leading to painful bone decay and loss, usually at the ends of bones such as those in the hip joint. Osteonecrosis of the hip joint usually requires hip replacement surgery.

In the general population, between 0.003 and 0.006 new cases of osteonecrosis are estimated to occur per hundred people, per year. Well-defined studies have not yet been conducted in HIV-positive people, but retrospective case studies have given estimates of 0.03 to 0.37 new cases per hundred per year. The purpose of this National Institutes of Health (NIH) study was to find the rate of new cases of osteonecrosis in a group of HIV-positive patients, and to study the natural history (progression) of the condition.

In 2002, the authors of the current paper reported that 15 (4.4%) of a group of 339 asymptomatic HIV-positive patients (at NIH clinics in Bethesda, Maryland) had osteonecrosis of the hip, confirmed by magnetic resonance imaging (MRI scan). Patients from this study were then enrolled in a prospective follow-up. Two hundred and thirty-nine participants who did not have osteonecrosis in the first study received a second MRI hip screening a median of 23 months after the first, between February 2001 and January 2002. New cases of osteonecrosis were diagnosed in three (1.3%) of these 239 patients – an incidence rate of 0.65 cases per hundred people per year.

Natural history

A follow-up ‘natural history’ study was done on a total of 40 HIV-positive people with osteonecrosis: the fifteen diagnosed in the first study, the th
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