Human Immunodeficiency Virus in the Focus of Bone Tissue Destruction in Patients With Aseptic Osteonecrosis of the Femoral Head: Two Case Reports

Background. Osteonecrosis of the femoral head is significantly more common in HIV-positive patients than in the general population. The etiology and pathogenesis of this process are not fully understood. In some studies, suggestions have been made about the possible direct pathological action of the virus on bone tissue cells. No studies dedicated to the identification of the virus directly in the foci of osteonecrosis were found in available literature sources. The aim of the study - to present the first clinical cases of patients with aseptic osteonecrosis of the femoral head in whom HIV RNA was found in the focus of bone necrosis. Cases presentation. Patients aged 54 and 38 years, suffering from HIV infection, were admitted to the clinic due to aseptic osteonecrosis of the femoral head. For diagnostic purposes, the patients underwent trephine biopsy of the osteonecrosis sites in the femoral head and unaltered bone tissue of the greater trochanter. The biological material was studied using PCR, microbiological, and histological methods. As a result of the PCR study, HIV RNA was detected in the foci of osteonecrosis in the femoral head. In the blood plasma of both patients, viral load was undetectable. In the bone tissue of the greater trochanter in the 54-year-old patient, the viral load was not determined, while in the 38-year-old patient, the viral load in the greater trochanter was significantly lower than in the necrosis focus of the femoral head. Conclusion. The obtained data may indicate the possibility of direct involvement of the virus in the pathogenesis of arthropathy and cast doubt on the aseptic nature of osteonecrosis in HIV-positive patients.