Osteonecrosis of the femoral head in people living with HIV: anatomopathological description and p24 antigen test

Figures & data

Table 1 Main demographic characteristics and those related to HIV infection and ART

Variables	Characteristics (n = 44)
Gender	Male – 37 (84.1%)
	Female – 7 (15.9%)
Time of HIV infection in years (average)	11.9 (4–24)
CD4 lymphocyte count/mm^3 of peripheral blood (average)	534.7 (55–1,238)
HIV viral load	Undetectable – 39 (88.4%)
	Detectable – 5 (11.6%)*
Time of exposure to ART in years (average)	10.1 (4–21)**
Number of ART regimens used (average)	4 (1–9)**
Metabolic changes	Dyslipidemia – 21 (47.7%)
	Lipodystrophy – 13 (30.9%)
	Hyperglycemia – 6 (13.6%)
	Osteoporosis – 1 (2.2%)
Alcoholism	22 (50.0%)
Smoking	34 (77.2%)
Steroids use	1 (2.2%)
Osteonecrosis	Bilateral – 31 (70.5%)
	Unilateral – 13 (29.5%)

Notes:

* Variation between 60 and 550,000 copies/mm³ average of 132,518 copies/mm³.

** Information available for 30 of the 44 patients.

Abbreviation: ART, antiretroviral therapy.

Table 2 Information about the use of antiretrovirals in the study population

Class of ARVs	Patients with previous or current use (n = 30)	Time of use in years (average)
NRTIs	30 (100.0%)	10.1 (4–21)
NNRTIs	25 (83.3%)	4.3 (1–11)
IPs	20 (66.7%)	5.2 (1–14)

Abbreviations: ARVs, antiretrovirals; NRTIs, nucleoside reverse transcriptase inhibitors; NNRTIs, nonnucleoside reverse transcriptase inhibitors; IPs, protease inhibitors.

Figure 1 Panel showing frequent changes in histological sections of femoral bone tissue of patients living with HIV and undergoing THA.

Abbreviation: THA, total hip arthroplasty.

Figure 2 Left: positive reaction with the monoclonal anti-p24 antibody in lymph node tissue from an HIV-positive patient during HAART (positive control). Right: negative reaction in bone tissue from an HIV-positive patient with osteonecrosis during HAART and undetectable viral load.

Abbreviation: HAART, highly active antiretroviral therapy.

Figure 3 Positive reaction with the monoclonal anti-CD68 antibody in femoral bone tissue of a patient living with HIV.