Corticosteroids linked to HIV-associated osteonecrosis

Use of corticosteroids may place HIV-infected patients at increased risk of developing osteonecrosis, according to a report in the August 15th issue of The Journal of Infectious Diseases. Awareness of this link may facilitate earlier detection of the disorder and improved treatment.

“Fortunately, clinically apparent osteonecrosis still appears to be uncommon, ” study director, Dr. Marshall J. Glesby, told Reuters Health. Nonetheless, the new findings suggest that “clinicians should have a low threshold to investigate musculoskeletal complaints, such as hip pain, in HIV-infected patients, especially those who have received corticosteroids in the past.”

Dr. Glesby, a researcher at the Weill Medical College of Cornell University, in New York City, looked for risk factors for HIV-associated osteonecrosis in a case-control study including 17 patients and 34 matched, HIV-infected controls.

Patients were more than 13 times more likely than controls to have a history of corticosteroids use, nearly 5 times more likely to have had an increase in CD4 cell count from a nadir above 50 cells/μL, and 7.6 times more likely to have had Pneumocystis carinii pneumonia. But in a multivariate analysis, only corticosteroid use was significantly associated with the development of HIV-associated osteonecrosis.

The findings suggest that HIV-infected patients who receive corticosteroids may be at increased future risk of developing osteonecrosis, Dr. Glesby explained in an interview. However, because the absolute risk of osteonecrosis remains low in this population, “the benefits of steroids” in some settings, such as for the treatment of Pneumocystis carinii pneumonia, “almost certainly outweigh the possible future risk of osteonecrosis, ” he added.

When prescribing corticosteroids to HIV-infected patients, “clinicians might want to carefully evaluate the risk-benefit ratio, ” the investigator suggested. When corticosteroids are prescribed in this population, he recommends vigilance in detecting early signs of osteonecrosis in order to ensure the best possible outcomes after surgical treatment. Screening for osteonecrosis in corticosteroids-treated patients does not appear to be warranted at this time.