Avascular necrosis

Todd T. Brown, M.D., Ph.D.
Avascular necrosis is a topic covered in the Johns Hopkins HIV Guide.

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PATHOGENS

  • 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