Lee Soon Ok, Lee Jeong Eun, Lee Shinwon, Lee Sun Hee, Kang Jin Suk, Lee In Sook, Moon Nam Hoon
Deparment of Internal Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
Deparment of Internal Medicine, Inje University School of Medicine, Pack Hospital, Busan, Korea.
Infect Chemother. 2020 Dec;52(4):592-599. doi: 10.3947/ic.2020.52.4.592. Epub 2020 Nov 2.
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.
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.
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/ mm³ (IQR: 161 - 551 cells/mm³). 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.
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.
股骨头坏死（ONFH）是一种致残性疾病，常需进行全髋关节置换术（THA）。虽然与普通人群相比，人类免疫缺陷病毒（HIV）感染者中ONFH的发生率更高，但关于韩国HIV感染者中ONFH的流行病学信息较少。在本研究中，我们旨在调查韩国HIV感染者中ONFH的发生率及临床特征。
在这项回顾性研究中，我们回顾了1990年1月至2019年12月期间接受治疗的1250例韩国HIV感染者的病历。使用标准化数据收集表获取临床信息。影像学数据由一名放射科医生根据2019年修订版的骨循环研究协会（ARCO）ONFH分期系统进行分析。
在纳入的1250例患者中，13例（1.04%；3例女性，10例男性）被诊断为ONFH。ONFH的总体发生率为每1000人年1.29例（95%置信区间[CI]：每1000人年0.7 - 2.4例）。13例ONFH患者的中位年龄为47岁（四分位间距[IQR]：41 - 57岁）。自HIV诊断以来的中位时间为4.8年（IQR：2.3 - 10.1年）。ONFH诊断时的中位CD4细胞计数为381个/立方毫米（IQR：161 - 551个/立方毫米）。在ONFH初诊时，83.3%的患者表现为双侧受累。83%的患者观察到ARCO 3期或4期骨坏死。在22个髋关节中，1期ONFH有2例（9.1%），2期ONFH有7例（31.8%），3期ONFH有9例（40.9%），4期ONFH有4例（18.2%）。最终84.6%的患者接受了THA。5例（38.5%）患者有类固醇使用史，4例（30.8%）患者有酗酒史，10例（76.9%）为吸烟者。8例（61.5%）患者有获得性免疫缺陷综合征定义疾病史，包括7例结核病患者和1例肺孢子菌肺炎患者。9例（69.2%）患者的最低CD4细胞计数<200/μL，3例（23.1%）有骨折史。总体而言，84%的患者接受过抗逆转录病毒治疗，而54%的患者服用蛋白酶抑制剂超过1年。
鉴于HIV感染者中ONFH的发生率相对较高，对于有危险因素以及腹股沟或髋部疼痛的HIV感染者，需要高度怀疑ONFH。
