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Avascular necrosis

Avascular necrosis is a topic covered in the Johns Hopkins HIV Guide.

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  • In general population, ethanol use and glucorticoid use account for 90% of cases. Other associated conditions include lupus, sickle cell disease, organ transplantation, antiphospholipid antibodies, trauma, radiation.
  • In HIV+ patients, incidence is 100x that of general population. Asymptomatic disease found in 6%.
  • Risk factors include low CD4 nadir, prior AIDS-defining illness, dyslipidemia, and traditional risk factors. Majority of patients exposed to glucocorticoids or megestrol.
  • Direct role of ART controversial. Pharmacologic inhibition of CYP3A4 may increase exogenous glucocorticoid exposure.
  • Exact pathogenesis is uncertain. Above risk factors may predispose to compromised local blood flow.

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Last updated: March 10, 2011


Brown, Todd T. "Avascular Necrosis." Johns Hopkins HIV Guide, 2011. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545016/all/Avascular_necrosis.
Brown TT. Avascular necrosis. Johns Hopkins HIV Guide. 2011. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545016/all/Avascular_necrosis. Accessed July 22, 2019.
Brown, T. T. (2011). Avascular necrosis. In Johns Hopkins HIV Guide. Available from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545016/all/Avascular_necrosis
Brown TT. Avascular Necrosis [Internet]. In: Johns Hopkins HIV Guide. ; 2011. [cited 2019 July 22]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545016/all/Avascular_necrosis.
* Article titles in AMA citation format should be in sentence-case
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