Department of Orthopedic, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
AIDS Res Hum Retroviruses. 2022 Nov;38(11):869-874. doi: 10.1089/AID.2021.0224. Epub 2022 Oct 19.
A lack of studies analyze risk factors for osteonecrosis of the femoral head (ONFH) in human immunodeficiency virus (HIV)-positive patients. We questioned (1) what clinical features of HIV-positive patients suffered with ONFH are; (2) what the independent risk factors for ONFH in HIV-positive patients are. A retrospective case-control study was performed in our institution from January 2013 to January 2020. A total of 57 HIV-positive patients with ONFH and 114 HIV-positive patients without ONFH were enrolled. Clinical characteristics of ONFH in HIV-positive patients were described. Multivariate logistic analysis was performed, respectively, to determine independent risk factors for ONFH in HIV-positive patients. Among 57 HIV-positive patients with ONFH, 35 patients (61.41%) were noted as Association Research Circulation Osseous stage 4. Independent risk factors of ONFH identified by multivariate analysis were prior lowest CD4 T lymphocyte count <50 [odds ratio = 4.800; 95% confidence interval (CI) = 1.194-19.296; = .027], tenofovir (TDF) use ≥1 year (odds ratio = 2.621; 95% CI = 1.199-5.729; = .016), and corticosteroid use ≥3 months (odds ratio = 8.932; 95% CI = 2.172-36.724; = .002). We recommend that orthopedic surgeons highly suspect the possibility of ONFH in HIV patients with prior lower CD4 T lymphocyte count, longer TDF, and corticosteroid use.
缺乏研究分析人类免疫缺陷病毒（HIV）阳性患者股骨头坏死（ONFH）的危险因素。我们提出疑问：（1）HIV 阳性患者并发 ONFH 的临床特征是什么；（2）HIV 阳性患者并发 ONFH 的独立危险因素是什么。我们在 2013 年 1 月至 2020 年 1 月在我院进行了一项回顾性病例对照研究。共纳入 57 例 HIV 阳性合并 ONFH 患者和 114 例 HIV 阳性未合并 ONFH 患者。描述了 HIV 阳性患者 ONFH 的临床特征。分别进行多变量 logistic 分析，以确定 HIV 阳性患者并发 ONFH 的独立危险因素。在 57 例 HIV 阳性合并 ONFH 患者中，35 例（61.41%）患者 Association Research Circulation Osseous 分期为 4 期。多变量分析确定的 ONFH 独立危险因素为：既往最低 CD4 淋巴细胞计数＜50[比值比（OR）=4.800；95%置信区间（CI）=1.194-19.296；P=.027]、使用替诺福韦（TDF）≥1 年（OR=2.621；95%CI=1.199-5.729；P=.016）和使用糖皮质激素≥3 个月（OR=8.932；95%CI=2.172-36.724；P=.002）。我们建议骨科医生高度怀疑 CD4 淋巴细胞计数较低、TDF 使用时间较长和糖皮质激素使用时间较长的 HIV 患者发生 ONFH 的可能性。
