Osteonecrosis of the hip, lipodystrophy and antiretroviral treatment

Fat distribution abnormalities and metabolic disturbances in HIV-infected patients receiving antiretroviral therapy have been extensively described during the past 3 years. The so-called `lipodystrophic syndromes' associate, to varying degrees, features of face and limb lipoatrophy, truncal obesity, visceral fat accumulation, hypercholesterolaemia and hypertriglyceridaemia, as well as insulin resistance, leading in some cases to overt diabetes. No consensus has been reached to date for a case definition of this syndrome, and its pathogeny remains obscure although antiretroviral drugs are most probably involved. We report on six patients (out of a cohort of 508 HIV-infected patients, including 280 on triple antiretroviral treatment) who were diagnosed with bilateral avascular necrosis of the femoral head, all between 1998 and January 2000.