2nd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 13-15 September 2000, Toronto, Canada

CASE-CONTROL STUDY OF AVASCULAR NECROSIS IN HIV-INFECTED PATIENTS

Antiviral Therapy 2000; 5(Suppl. 5):21 (abstract no. O33)

M J Glesby and C M Vaamonde
Cornell University Medical College, New York, N.Y., USA

BACKGROUND: Cases of avascular necrosis (AVN) of the femoral head have been reported since early in the HIV epidemic. Recent reports have suggested an association with protease inhibitor (PI) use, but data with appropriate controls are limited.

OBJECTIVES: To ascertain potential factors associated with AVN in an urban HIV clinic.

DESIGN: Cases of AVN were ascertained and two controls/case randomly selected and matched on date of initial clinic visit and baseline CD4 stratum.

RESULTS: Fourteen cases of AVN of the femoral head diagnosed 1992-2000 were identified. All but two cases were after 1996, and eight (57%) had bilateral AVN. Median CD4 and geometric mean HIV RNA at time of AVN were 164 cells/mm³ and 3.8 log₁₀ copies/ml. Cases and controls did not differ significantly by year of HIV diagnosis; race; gender; HIV risk factor; HCV or HBV serostatus; history of alcoholism, smoking, cancer, diabetes or pancreatitis; CD4, nadir CD4 or HIV RNA; random glucose or triglycerides. Duration of antiretroviral therapy (ART) prior to AVN was longer in cases (median 32 versus 14 months; P=0.06). Seventy-one percent of cases used PIs prior to, and 57% at the time of AVN diagnosis versus 57 and 32%, respectively, of controls at comparable time points (P=0.50 and 0.18, respectively). In matched univariate analyses, prior Pneumocystis carinii pneumonia (PCP; odds ratio [OR] 6.3; 95% confidence interval [CI] 1.3-31; P=0.02), CD4 rise >50 cells/mm³ from nadir (OR 4.3; CI 0.85-22; P=0.08), known prior corticosteroid use (OR 6.6; CI 0.72-61; P=0.10), PI use at time of AVN (OR 4.0; CI 0.77-21; P=0.10), and stavudine use at time of AVN(OR 2.5; CI 0.80-8.1; P=0.11) were associated with AVN. In multivariate models only prior PCP remained independently associated with AVN.

CONCLUSIONS: AVN was associated with prior PCP (a possible marker of corticosteroid use). Use of specific ART, including PIs, was not independently associated. Further investigation with a larger sample is needed to confirm these findings.

000913
O33

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