Orthopedics and Traumatology Department, University of Sassari, Italy.
Infectious Diseases Department, Viale San Pietro 24, 07100 Sassari, Italy .
Acta Biomed. 2022 Mar 10;92(S3):e2021560. doi: 10.23750/abm.v92iS3.12551.
Recently, the interest on multifocal avascular necrosis (AVN) among people living with HIV (PLWH) is rising. PLWH have an incidence of symptomatic AVN significantly higher than the general population. The chronic viral infection may induce a direct damage via necrotizing vasculitis, on the other hand the highly active antiretroviral therapy represents a probable risk factor as it can indirectly lead to multifocal necrosis. Regardless of etiopathology, the AVN management in PLWH is the same as in the general population. Depending on symptoms, stage, and location, the AVN can be treated conservatively or surgically, but in its final stages joint replacement is often the most appropriate therapeutic option. The safety and outcomes of such major orthopedic surgery in PLWH are debated topics. In agreement with the literature in our case series we observed, despite some complication, a significant pain relief and excellent recovery of function after hip replacements. Although increased complication rates, several other independent risk factors associated with HIV infection can act as confounding factors. These confounders must be taken into account both in clinical practice and in data analysis. This case-based review highlights the increasing incidence of AVN in PLWH, and emphasizes the safety and effectiveness of the prosthetic joint replacement in this population.
最近，人们对 HIV 感染者（PLWH）多发性缺血性骨坏死（AVN）的兴趣日益增加。PLWH 患症状性 AVN 的发病率明显高于普通人群。慢性病毒感染可能通过坏死性血管炎直接造成损害，另一方面，高效抗逆转录病毒疗法可能是一个潜在的危险因素，因为它可能间接导致多灶性坏死。无论病因如何，PLWH 的 AVN 管理与普通人群相同。根据症状、阶段和位置，AVN 可以保守治疗或手术治疗，但在晚期，关节置换通常是最合适的治疗选择。PLWH 进行这种大型骨科手术的安全性和结果是有争议的话题。与我们观察到的文献一致，尽管存在一些并发症，我们观察到髋关节置换术后疼痛明显缓解，功能恢复良好。尽管并发症发生率增加，但与 HIV 感染相关的其他几个独立危险因素可能会成为混杂因素。在临床实践和数据分析中都必须考虑到这些混杂因素。本病例回顾强调了 PLWH 中 AVN 发病率的增加，并强调了在该人群中假体关节置换的安全性和有效性。
