Idiopathic Bilateral HIV-Associated Osteonecrosis of Femoral Heads

Abstract

Background: Avascular necrosis (osteonecrosis) is an increasingly recognized complication in patients living with HIV, particularly when weight-bearing joints such as the hip are involved. Although previously attributed primarily to antiretroviral therapy, HIV infection itself may be an independent risk factor.

Case Report: A 33-year-old woman with HIV infection diagnosed three years earlier presented with an eight-month history of progressively worsening bilateral hip pain, eventually resulting in an inability to ambulate without assistance. Clinical examination was suggestive of avascular necrosis, which was confirmed by bilateral hip radiographs and magnetic resonance imaging, demonstrating Steinberg Stage IV disease. There was no history of other recognized causes of osteonecrosis. She was compliant with highly active antiretroviral therapy (HAART) consisting of tenofovir, emtricitabine, and efavirenz. The advanced disease at presentation suggests that osteonecrosis may have developed substantially earlier than expected in the course of her HIV infection.

Conclusion: Although HAART may be associated with avascular necrosis, HIV infection itself may represent an independent risk factor. This case highlights that severe osteonecrosis may develop early in the course of HIV infection, emphasizing the importance of early recognition of musculoskeletal symptoms in these patients.