Osteonecrosis, a disabling complication associated with antiretroviral
therapy (ART) and human immunodeficiency virus (
HIV) infection, has rarely been reported in an Asian population. After an observation of 3,250 person-years (
PY), 11 of 967 (1.1%) HIV-infected patients at a median age of 34 years developed
osteonecrosis involving the hip joints (incidence, 3.4 per 1,000 PY). Their median CD4+ lymphocyte count had increased from 35 cells/microL at the diagnosis of
HIV infection to 297 cells/microL at the diagnosis of
osteonecrosis. The crude rate of
osteonecrosis increased from 0% in patients without exposure to ART to 2.6 and 1.7% in patients with exposure to
nucleoside reverse transcriptase inhibitors (NRTIs) and who had undergone
highly active antiretroviral therapy (
HAART) for 5 years or longer, respectively (P=0.18 and 0.09, respectively). Among the patients receiving
HAART, the estimated incidence of
osteonecrosis was 4.2 per 1,000 PY. Patients with
osteonecrosis had a longer duration of exposure to NRTIs (1,641 versus 1,264 days, P=0.26) and to
HAART (1,603 versus 1,251 days, P=0.42), a higher serum
triglyceride (median, 1,130 versus 351 mg/dL; P=0.09), and a higher proportion of
lipodystrophy (81.8 versus 15.0%, P<0.0001). Our report suggests that
osteonecrosis is a rare complication in HIV-infected patients with prolonged exposure to ART with resultant metabolic complications.