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    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

    Citation

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    TY - ELEC T1 - Avascular necrosis ID - 545016 A1 - Brown,Todd,M.D., Ph.D. Y1 - 2011/03/10/ BT - Johns Hopkins HIV Guide UR - https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545016/all/Avascular_necrosis DB - Johns Hopkins Guide DP - Unbound Medicine ER -