Osteonecrosis in human immunodeficiency virus (HIV)-infected patients: a multicentric case-control study
Osteonecrosis in human immunodeficiency virus (HIV)-infected patients: a multicentric case-control study
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DOI：
10.1007/s00774-010-0245-5
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发表时间：
2011-05-01
影响因子：
3.3
通讯作者：
Parruti, Giustino
中科院分区：
文献类型：
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作者：
Mazzotta, Elena;Agostinone, Adriana;Parruti, Giustino
骨坏死（ON）是一种罕见的致残性并发症，发生在人类免疫缺陷病毒（HIV）感染的患者中，尽管有有效的联合抗逆转录病毒治疗，但发生率高于一般人群，最近几项回顾性研究证实了这一点。我们设计了一项多中心病例对照研究，在意大利CISAI组（意大利HIV感染不良事件研究组）的机构中接受治疗的HIV感染患者中寻找这一特殊人群中ON的其他预测因素。要求观察到至少1例ON病例的所有中心报告数据，以进行中心再评价。随机选择平行HIV阳性、无ON的对照，并在HIV诊断时与确诊ON病例的性别、年龄和CD 4 T细胞计数相匹配。最终样本中包括15例病例和对照。单变量统计分析显示ON与类固醇暴露之间存在显著相关性（P = 0.001），除HAART外还暴露于一种或多种药物（高活性抗逆转录病毒治疗）（P = 0.03），血清总IgE滴度高（P = 0.02），丧失工作能力（P = 0.03），抗逆转录病毒治疗前甘油三酯水平超过200 mg/dL（P = 0.03）和胆固醇水平超过200 mg/dL之前和之后的抗逆转录病毒（P = 0.03和0.05分别）。高血清IgE水平和工作能力的丧失提前ON首次出现作为可能的预测ON的HIV患者，而长期暴露于类固醇，合并高血糖症和慢性治疗与其他药物，除了抗逆转录病毒药物被证实。因此，在个体HIV感染患者中预测和预防ON是临床上具有挑战性的机会。
Osteonecrosis (ON) is a rare disabling complication occurring in patients with human immunodeficiency virus (HIV) infection at a higher frequency than in the general population despite effective combination antiretroviral therapy being made available, as recently documented by several retrospective studies. We designed a multicentric case-control study among HIV-infected patients cared for at institutions in the Italian CISAI group (Italian Study Group for Adverse Events in HIV Infection) to search for additional predictors of ON in this special population. All centers which observed at least one case of ON were requested to report data for central re-evaluation. Parallel HIV-positive, ON-free controls were randomly selected and matched with confirmed cases of ON for sex, age and CD4 T-cell counts at the time of HIV diagnosis. Fifteen cases and controls were included in the final sample. Univariate statistical analyses revealed a significant association between ON and exposure to steroids (P = 0.001), exposure to one or more drugs in addition to HAART (Highly Active Anti-Retroviral Therapy) (P = 0.03), high titers of total serum IgE (P = 0.02), loss of working ability (P = 0.03), triglycerides levels over 200 mg/dL before antiretrovirals (P = 0.03) and cholesterol levels over 200 mg/dL before and after antiretrovirals (P = 0.03 and 0.05, respectively). High serum IgE levels and loss of working ability in advance of ON appeared for the first time as possible predictors of ON in HIV patients, while long-term exposure to steroids, combined hyperlipemia and chronic treatment with other drugs in addition to antiretrovirals were confirmed. Predicting and preventing ON in the individual HIV-infected patient is therefore a clinically challenging opportunity.