Clinical observations of HIV-infected patients with the femoral head necrosis

Introduction: HIV infection is often accompanied by the development of the femoral head necrosis, but the pathogenesis of this process is still not fully understood. There are few studies in the literature indicating a direct effect of human immunodefi cy virus on osteocytes and osteoblasts. In previously published clinical observations, we presented data on the detection of human immunodefi cy virus RNA directly in foci of osteonecrosis of the femoral head, including those with undetectable viral load in the blood [12].Purpose of the study: to present the fi st results of clinical observations in HIV-infected patients with femoral head necrosis, in whom HIV RNA was detected in the focus of bone necrosis.Methods: patients with HIV infection and femoral head necrosis with undetectable viral load in blood plasma, in whom the viral load in the foci of bone destruction was determined by PCR, were included in the study (n=16). Based on the study of the biopsy material, patients were divided into two groups based on the presence of bacterial agent (coxitis) (n=7, group 1) and its absence (aseptic necrosis) (n=9, group 2).Results: despite the absence of a significant difference in the groups in terms of the level of CD4 T-lymphocytes, the number of patients with severe immunodefi cy (CD4 T-lymphocytes less than 350 cells/μl) in the group 1 was 42.9% (3/7), in the group 2 was 22.2% (2/9), which suggests, with increasing sample sizes, a greater severity of immunodefi cy in patients with coxitis. Viral load in foci of necrosis in patients of both groups was signifi antly higher than the undetectable level. In the group 1 treatment was carried out with a with a cement spacer saturated with antimicrobial agents, depending on the individual sensitivity of the pathogen. In the group 2 one-stage arthroplasty was performed. During the follow-up period from 4 to 16 months in the group 1 the average Harris scale score after the fi st stage of surgery was 61.2±2.4 (23.4±5.1 on admission), and in both patients with tuberculous coxitis progression of the local specifi process was noted. In the group 2 after treatment the average Harris score was 87,2±4,5 against 26,7±7,6 on admission, no postoperative complications were noted during the observed period.