Associations between antiretroviral treatment and avascular bone necrosis: The Swiss HIV Cohort Study. Open Forum Infectious Diseases.
Bayard et al. aimed to study the associations of antiretroviral therapy (ART) with the occurrence of avascular bone necrosis (AVN) among Swiss HIV Cohort Study participants. For each case with confirmed AVN, they randomly selected SHCS participants without any signs of AVN and matched these controls for gender, SHCS registration date, and last follow-up date.
The authors analyzed 219 SHCS participants, 74 with AVN and 145 controls. AVN was located in the femoral head in 59 (80%) participants. In the adjusted models, associations with AVN were shown for heterosexual HIV acquisition (odds ratio [OR], 3.4), alcohol consumption (OR, 2.7), and hyperlipidemia (OR, 3.6). After adding ART substances to the multivariable base model, there was evidence of an association for treatment with tenofovir (TDF) >1 year (OR, 4.4) with AVN. Neither exposure to specific frequently prescribed ART combinations or ART drug classes nor cumulative ART exposure showed any associations with AVN.
In conclusion, the study-results confirm previously recorded AVN risk factors such as heterosexual HIV acquisition, moderate/severe alcohol consumption, hyperlipidemia, and corticosteroid use >3 months (trend). The finding of an increased risk for AVN in heterosexual HIV acquisition is probably mediated by advanced immunosuppression, considering the fact that heterosexual participants in the study were more likely to be late presenters compared with other transmission groups. The observation that TDF contributes to AVN needs to be confirmed in other patient populations. However, a recent study in a large international HIV cohort did not find any association of antiretrovirals with osteonecrosis.