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논문 기본 정보

자료유형
학술저널
저자정보
Lee Soon Ok (Deparment of Internal Medicine Pusan National University School of Medicine Medical Research Instit) Lee Jeong Eun (Deparment of Internal Medicine Pusan National University School of Medicine Medical Research Instit) 이신원 (부산대학교) 이선희 (Deparment of Internal Medicine Pusan National University School of Medicine Medical Research Instit) Kang Jin Suk (Deparment of Internal Medicine Inje University School of Medicine Pack Hospital Busan Korea.) 이인숙 (Deparment of Radiology Pusan National University School of Medicine Pusan National University Hospi) 문남훈 (부산대학교)
저널정보
대한감염학회 Infection and Chemotherapy Infection and Chemotherapy 제52권 제4호
발행연도
2020.1
수록면
592 - 599 (8page)

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Background: Osteonecrosis of the femoral head (ONFH) is a disabling condition that often necessitates total hip arthroplasty (THA). Although ONFH occurs more frequently among patients with human immunodeficiency virus (HIV) than among the general population, there is little epidemiological information regarding ONFH in Korean patients with HIV. In the present study, we aimed to investigate the incidence and clinical features of ONFH among Korean patients with HIV. Materials and Methods: In this retrospective study, we reviewed the medical records of 1,250 Korean patients with HIV treated from January 1990 to December 2019. A standardised data collection sheet was used to obtain clinical information. Imaging data were analysed by a radiologist in accordance with the 2019 revised version of the Association Research Circulation Osseous (ARCO) staging system for ONFH. Results: Among the 1,250 included patients, 13 patients (1.04%; 3 women, 10 men) were diagnosed with ONFH. The overall incidence of ONFH was 1.29 per 1,000 person-years (PYs) (95% confidence interval [CI]: 0.7 ? 2.4 per 1,000 PYs). Median age among the 13 patients with ONFH was 47 years (interquartile range [IQR]: 41 ? 57 years). The median duration since HIV diagnosis was 4.8 years (IQR: 2.3 ? 10.1 years). The median CD4 cell count at the time of ONFH diagnosis was 381 cells/ mm3 (IQR: 161 ? 551 cells/mm3 ). At the initial diagnosis of ONFH, 83.3% of patients exhibited bilateral involvement. ARCO stage 3 or 4 osteonecrosis was observed in 83% of patients. Among 22 hips, stage 1 ONFH was noted in 2 (9.1%), stage 2 ONFH was noted in 7 (31.8%), stage 3 ONFH was noted in 9 (40.9%), and stage 4 ONFH was noted in 4 (18.2%). THA was eventually performed in 84.6% of patients. Five (38.5%) patients had a history of steroid use, 4 (30.8%) patients had a history of alcohol abuse and 10 (76.9%) were smokers. Eight (61.5%) patients had a history of acquired immune deficiency syndrome-defining illness, including 7 with tuberculosis and 1 with pneumocystis pneumonia. Nine patients (69.2%) had a nadir CD4 cell count <200/μL, and 3 (23.1%) had a history of bone fracture. Overall, 84% of patients were exposed to antiretroviral therapy, while 54% had taken protease inhibitors for more than 1 year. Conclusion: Considering that relatively high incidence of ONFH in patients with HIV, a high index of suspicion for those with risk factors and those with groin or hip pain for is required in HIV-infected patients.
#Osteonecrosis #Femoral head #Hip #HIV

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참고문헌 (22)

참고문헌 신청
Yoon BH / 2020 / The 2019 revised version of association research circulation osseous staging / J Arthroplasty 35:933~940 google schola Lamb JN / 2019 / Avascular necrosis of the hip / BMJ 365:l2178 google schola Morse CG / 2007 / The incidence and natural history of osteonecrosis in HIV-infected adults / Clin Infect Dis 44:739~748 google schola Permpalung N / 2014 / Protease inhibitors and avascular necrosis : a systematic review and meta-analysis / Int J Antimicrob Agents 44:93~95 google schola Mary-Krause M / 2006 / Risk factors for osteonecrosis in HIV-infected patients : impact of treatment with combination antiretroviral therapy / AIDS 20:1627~1635 google schola

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