[Bilateral aseptic osteonecrosis of fernoral head in an HIV-infected patient]

ABSTRACT

The incidence of osteonecrosis has increased in HIV-infected patients. The femoral head is the most frequent localization and bilateral in the 60% of cases. Common risk factors include the use of corticosteroids, ethanol and the hyperlipidemia. We report one case of bilateral femoral head of osteonecrosis in an HIV-infected patient. A 40-years-old HIV-infected patient, with advanced immunodeficiency [CD4+ cell count of 55/mm3]. His past medical history included cervical zoster, significant alcohol abuse, chronic smoking and use of corticosteroids by himself in 1992. He is currently treated with antiretroviral therapy combined Zidovudine, Lamivudine and Efavirenz. He was admitted to hospital in December 2003 with progressive bilateral hip pain and limp without fever. Osteonecrosis was diagnosed by magnetic resonance imaging and skeletal scintigraphy .Laboratory test showed hypercholesterolemia, positive antiphospholipid and antinuclear antibody. He was treated with nonsteroidal anti-inflammatory drugs. Total joint arthroplasty was not realised due to severe immunodeficiency and high risk of infection. In accordance with the literature, the risk factors for osteonecrosis are multiple in our patient. This fact, a large vigilance is necessary among HIV-infected patients having a dyslipidemy and/or received corticosteroids