[Osteonecrosis in HIV-infected patients and its correlation with highly active antiretroviral therapy (HAART)].

INTRODUCTION: The incidence of osteonecrosis has increased in HIV-infected patients over the last few years, and has been considered as a side effect of highly active antiretroviral therapy (HAART), possibly related to drug-induced hyperlipidemia. We report seven cases. OBSERVATIONS: Seven HIV-infected persons, 6 males and one female, aged 29 to 49 years, and with advanced immunodeficiency (lymphocyte CD4 count<250 cells/mm3 in all the cases). Osteonecrosis generally involved the head of the femoral, clinically presented pain and difficulty walking, and was diagnosed by magnetic resonance imaging or skeletal scintigraphy. COMMENTS: Among these 7 patients with osteonecrosis, only 4 received antiretroviral therapy at the time of the diagnosis, one presented moderate hypertriglyceridemia, and 3 had positivity for the anti-phospholipid antibodies. Hence, HAART, dyslipidemia, and auto-immunity may enhance, but are not necessarily elements in the onset of HIV-associated avascular bone necrosis.