Whitlock G G, Herbert S, Copas A, Gilson R, Ainsworth J G
Centre for Sexual Health & HIV Research, Research Department of Infection and Population Health, University College London, London, UK.
Int J STD AIDS. 2013 Oct;24(10):799-803. doi: 10.1177/0956462413482814. Epub 2013 Jul 10.
This study investigates the association of avascular necrosis (AVN) in human immunodeficiency virus (HIV)-positive individuals with possible risk factors, including antiretroviral therapy. Clinic records of all AVN cases diagnosed up to July 2009 in HIV-positive patients attending North Middlesex Hospital, London, UK were retrospectively reviewed. For each case, one control was randomly selected, matched for gender, age, nadir CD4 count and date of HIV diagnosis. Of 15 symptomatic AVN cases identified, eight were in women. Univariate analysis demonstrated significant associations between AVN and a history of systemic steroid use (p = 0.004) and cumulative exposure to protease inhibitor (p = 0.03). Physicians should be aware of the risk of AVN with steroid use, the importance of early diagnosis and avoidance of other risk factors in order to prevent further joint involvement if possible.
本研究调查了人类免疫缺陷病毒（HIV）阳性个体中无血管性坏死（AVN）与包括抗逆转录病毒疗法在内的可能风险因素之间的关联。对截至2009年7月在英国伦敦北米德尔塞克斯医院就诊的HIV阳性患者中诊断出的所有AVN病例的临床记录进行了回顾性审查。对于每个病例，随机选择一名对照，根据性别、年龄、最低CD4细胞计数和HIV诊断日期进行匹配。在15例有症状的AVN病例中，8例为女性。单因素分析表明，AVN与全身使用类固醇病史（p = 0.004）和蛋白酶抑制剂的累积暴露（p = 0.03）之间存在显著关联。医生应意识到使用类固醇会有AVN的风险、早期诊断的重要性以及避免其他风险因素，以便尽可能防止进一步的关节受累。
