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Osteonecrosis of the Femoral Head in Korean Patients with Human Immunodeficiency Virus Infection
BACKGROUND: Osteonecrosis of the femoral head (ONFH) is a disabling condition that often necessitates total hip arthroplasty (THA). Although ONFH occurs more frequently among patients with human immunodeficiency virus (HIV) than among the general population, there is little epidemiological informati...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Society of Infectious Diseases; Korean Society for Antimicrobial Therapy; The Korean Society for AIDS
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779977/ https://www.ncbi.nlm.nih.gov/pubmed/33263239 http://dx.doi.org/10.3947/ic.2020.52.4.592 |
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author | Lee, Soon Ok Lee, Jeong Eun Lee, Shinwon Lee, Sun Hee Kang, Jin Suk Lee, In Sook Moon, Nam Hoon |
author_facet | Lee, Soon Ok Lee, Jeong Eun Lee, Shinwon Lee, Sun Hee Kang, Jin Suk Lee, In Sook Moon, Nam Hoon |
author_sort | Lee, Soon Ok |
collection | PubMed |
description | BACKGROUND: Osteonecrosis of the femoral head (ONFH) is a disabling condition that often necessitates total hip arthroplasty (THA). Although ONFH occurs more frequently among patients with human immunodeficiency virus (HIV) than among the general population, there is little epidemiological information regarding ONFH in Korean patients with HIV. In the present study, we aimed to investigate the incidence and clinical features of ONFH among Korean patients with HIV. MATERIALS AND METHODS: In this retrospective study, we reviewed the medical records of 1,250 Korean patients with HIV treated from January 1990 to December 2019. A standardised data collection sheet was used to obtain clinical information. Imaging data were analysed by a radiologist in accordance with the 2019 revised version of the Association Research Circulation Osseous (ARCO) staging system for ONFH. RESULTS: Among the 1,250 included patients, 13 patients (1.04%; 3 women, 10 men) were diagnosed with ONFH. The overall incidence of ONFH was 1.29 per 1,000 person-years (PYs) (95% confidence interval [CI]: 0.7 – 2.4 per 1,000 PYs). Median age among the 13 patients with ONFH was 47 years (interquartile range [IQR]: 41 – 57 years). The median duration since HIV diagnosis was 4.8 years (IQR: 2.3 – 10.1 years). The median CD4 cell count at the time of ONFH diagnosis was 381 cells/ mm(3) (IQR: 161 – 551 cells/mm(3)). At the initial diagnosis of ONFH, 83.3% of patients exhibited bilateral involvement. ARCO stage 3 or 4 osteonecrosis was observed in 83% of patients. Among 22 hips, stage 1 ONFH was noted in 2 (9.1%), stage 2 ONFH was noted in 7 (31.8%), stage 3 ONFH was noted in 9 (40.9%), and stage 4 ONFH was noted in 4 (18.2%). THA was eventually performed in 84.6% of patients. Five (38.5%) patients had a history of steroid use, 4 (30.8%) patients had a history of alcohol abuse and 10 (76.9%) were smokers. Eight (61.5%) patients had a history of acquired immune deficiency syndrome-defining illness, including 7 with tuberculosis and 1 with pneumocystis pneumonia. Nine patients (69.2%) had a nadir CD4 cell count <200/µL, and 3 (23.1%) had a history of bone fracture. Overall, 84% of patients were exposed to antiretroviral therapy, while 54% had taken protease inhibitors for more than 1 year. CONCLUSION: Considering that relatively high incidence of ONFH in patients with HIV, a high index of suspicion for those with risk factors and those with groin or hip pain for is required in HIV-infected patients. |
format | Online Article Text |
id | pubmed-7779977 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | The Korean Society of Infectious Diseases; Korean Society for Antimicrobial Therapy; The Korean Society for AIDS |
record_format | MEDLINE/PubMed |
spelling | pubmed-77799772021-01-05 Osteonecrosis of the Femoral Head in Korean Patients with Human Immunodeficiency Virus Infection Lee, Soon Ok Lee, Jeong Eun Lee, Shinwon Lee, Sun Hee Kang, Jin Suk Lee, In Sook Moon, Nam Hoon Infect Chemother Original Article BACKGROUND: Osteonecrosis of the femoral head (ONFH) is a disabling condition that often necessitates total hip arthroplasty (THA). Although ONFH occurs more frequently among patients with human immunodeficiency virus (HIV) than among the general population, there is little epidemiological information regarding ONFH in Korean patients with HIV. In the present study, we aimed to investigate the incidence and clinical features of ONFH among Korean patients with HIV. MATERIALS AND METHODS: In this retrospective study, we reviewed the medical records of 1,250 Korean patients with HIV treated from January 1990 to December 2019. A standardised data collection sheet was used to obtain clinical information. Imaging data were analysed by a radiologist in accordance with the 2019 revised version of the Association Research Circulation Osseous (ARCO) staging system for ONFH. RESULTS: Among the 1,250 included patients, 13 patients (1.04%; 3 women, 10 men) were diagnosed with ONFH. The overall incidence of ONFH was 1.29 per 1,000 person-years (PYs) (95% confidence interval [CI]: 0.7 – 2.4 per 1,000 PYs). Median age among the 13 patients with ONFH was 47 years (interquartile range [IQR]: 41 – 57 years). The median duration since HIV diagnosis was 4.8 years (IQR: 2.3 – 10.1 years). The median CD4 cell count at the time of ONFH diagnosis was 381 cells/ mm(3) (IQR: 161 – 551 cells/mm(3)). At the initial diagnosis of ONFH, 83.3% of patients exhibited bilateral involvement. ARCO stage 3 or 4 osteonecrosis was observed in 83% of patients. Among 22 hips, stage 1 ONFH was noted in 2 (9.1%), stage 2 ONFH was noted in 7 (31.8%), stage 3 ONFH was noted in 9 (40.9%), and stage 4 ONFH was noted in 4 (18.2%). THA was eventually performed in 84.6% of patients. Five (38.5%) patients had a history of steroid use, 4 (30.8%) patients had a history of alcohol abuse and 10 (76.9%) were smokers. Eight (61.5%) patients had a history of acquired immune deficiency syndrome-defining illness, including 7 with tuberculosis and 1 with pneumocystis pneumonia. Nine patients (69.2%) had a nadir CD4 cell count <200/µL, and 3 (23.1%) had a history of bone fracture. Overall, 84% of patients were exposed to antiretroviral therapy, while 54% had taken protease inhibitors for more than 1 year. CONCLUSION: Considering that relatively high incidence of ONFH in patients with HIV, a high index of suspicion for those with risk factors and those with groin or hip pain for is required in HIV-infected patients. The Korean Society of Infectious Diseases; Korean Society for Antimicrobial Therapy; The Korean Society for AIDS 2020-12 2020-11-02 /pmc/articles/PMC7779977/ /pubmed/33263239 http://dx.doi.org/10.3947/ic.2020.52.4.592 Text en Copyright © 2020 by The Korean Society of Infectious Diseases, Korean Society for Antimicrobial Therapy, and The Korean Society for AIDS https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Lee, Soon Ok Lee, Jeong Eun Lee, Shinwon Lee, Sun Hee Kang, Jin Suk Lee, In Sook Moon, Nam Hoon Osteonecrosis of the Femoral Head in Korean Patients with Human Immunodeficiency Virus Infection |
title | Osteonecrosis of the Femoral Head in Korean Patients with Human Immunodeficiency Virus Infection |
title_full | Osteonecrosis of the Femoral Head in Korean Patients with Human Immunodeficiency Virus Infection |
title_fullStr | Osteonecrosis of the Femoral Head in Korean Patients with Human Immunodeficiency Virus Infection |
title_full_unstemmed | Osteonecrosis of the Femoral Head in Korean Patients with Human Immunodeficiency Virus Infection |
title_short | Osteonecrosis of the Femoral Head in Korean Patients with Human Immunodeficiency Virus Infection |
title_sort | osteonecrosis of the femoral head in korean patients with human immunodeficiency virus infection |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779977/ https://www.ncbi.nlm.nih.gov/pubmed/33263239 http://dx.doi.org/10.3947/ic.2020.52.4.592 |
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