Subtrochanteric Pathological Femur Fracture in an HIV-Positive Patient on Tenofovir-based antiretroviral therapy: A Case Report and Review of the Literature

INTRODUCTION: The population of people living with human immunodeficiency virus (HIV) and AIDS has increased and so is the incidence of fragility fractures in these patients. Multiple contributory factors are responsible for osteomalacia or osteoporosis in such patients such as a chronic inflammatory response to the HIV, highly active antiretroviral therapy (HAART) itself, and associated comorbidities. Tenofovir has also been reported to disrupt bone metabolism and causes fragility fractures. CASE REPORT: A 40-year-old HIV-positive female came to us with pain in her left hip and was unable to bear weight. She had a history of trivial fall. The patient has been taking tenofovir-associated HAART regimen for the past 6 years and has been compliant. She was diagnosed with a left-side transverse subtrochanteric closed femur fracture. Closed reduction and internal fixation was done using a proximal femur intramedullary nail (PFNA). The latest follow-up shows fracture union and good functional outcomes after treating osteomalacia, and HAART changed to a non-tenofovir regimen later. CONCLUSION: Patients with HIV infection are prone to fragility fractures and periodic monitoring of their BMD, serum calcium, and vitamin D3 levels should be done for prevention and early diagnosis. More vigilance in patients receiving a tenofovir-associated HAART regimen is needed. Appropriate medical treatment needs to be started once any abnormality in the bone metabolic parameters is detected, and drugs like tenofovir need to be changed as it causes osteomalacia.