Risk Factors for Osteonecrosis of the Femoral Head in Human Immunodeficiency Virus-Positive Patients: A Retrospective Case-Control Study

A lack of studies analyze risk factors for osteonecrosis of the femoral head (ONFH) in human immunodeficiency virus (HIV)-positive patients. We questioned (1) what clinical features of HIV-positive patients suffered with ONFH are; (2) what the independent risk factors for ONFH in HIV-positive patients are. A retrospective case-control study was performed in our institution from January 2013 to January 2020. A total of 57 HIV-positive patients with ONFH and 114 HIV-positive patients without ONFH were enrolled. Clinical characteristics of ONFH in HIV-positive patients were described. Multivariate logistic analysis was performed, respectively, to determine independent risk factors for ONFH in HIV-positive patients. Among 57 HIV-positive patients with ONFH, 35 patients (61.41%) were noted as Association Research Circulation Osseous stage 4. Independent risk factors of ONFH identified by multivariate analysis were prior lowest CD4(+) T lymphocyte count <50 [odds ratio = 4.800; 95% confidence interval (CI) = 1.194-19.296; p = .027], tenofovir (TDF) use >= 1 year (odds ratio = 2.621; 95% CI = 1.199-5.729; p = .016), and corticosteroid use >= 3 months (odds ratio = 8.932; 95% CI = 2.172-36.724; p = .002). We recommend that orthopedic surgeons highly suspect the possibility of ONFH in HIV patients with prior lower CD4(+) T lymphocyte count, longer TDF, and corticosteroid use.