Question:

Dear Dr:
I have been HIV+ since 1986, relative good health. Started HIV meds only 6 months ago and now extremely compliant. T4 counts rose from 11 to 78, Viral load 140,000 to undetectable. Quit drinking and started exercise. Now, exercise is impossible. My hip must be replaced. Dr. said the bone died and is now collapsing. He knows I have AIDS. I can't believe all this is happening so quick after I started to take such good care of myself. Can this be caused by AIDS, medications, a combination of all, or maybe it was always there but I never noticed it because of my drinking? I must use a walker. Can't put any weight at all on it. Should I have the total hip replacement the surgeon wants to do?

Answer provided by:

Ross Slotten, M.D.
Klein and Slotten Medical Associates
Private Practice in Family Medicine
With a special interest in HIV disease

You state that you just began treating your HIV infection, with excellent results. However, since starting that therapy, you have developed a problem with your hip. Your description of the "death" and collapse of the bone sounds like avascular necrosis, a condition that can occur in almost anyone. In avascular necrosis, the blood supply to the hip is somehow cut off. One of the most common causes is prednisone, a steroid that can be used for a variety of conditions, like asthma. Smoking is another cause. Some patients with long-standing HIV infection who have been treated for years with HIV medications can develop osteoporosis as well as avascular necrosis. For all of these conditions, however, no one exactly knows why avascular necrosis occurs.

Unfortunately, you will need to have this hip surgery. Otherwise, you'll be miserable and unable to walk.

Sincerely,
Ross A. Slotten, M.D.

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