Hip Pain and Fractures in People With HIV

Risk of hip fracture 58 times greater than U.S. population

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The problem starts out innocently enough with some vague discomfort in the leg, especially in the groin area. Later, the pain becomes more severe and starts to involve the hip. Within a short period of time, walking will become difficult, and the pain will grow in intensity until it eventually feels unbearable. It is only that this stage that most people will see a doctor.

Among people with HIV, these sorts of symptoms can mean any number of things, some of which are related to the infection and others that are not.

However, one of the more common causes is a degenerative bone disorder of the hip known as avascular necrosis, or AVN.

Understanding Avascular Necrosis

Avascular necrosis is a bone and vascular disease which is being seen with greater frequency in people with long-term HIV infection. Also known as osteonecrosis, AVN is a type of bone cell death caused by a diminishing blood supply to the bones. Blood flow is typically impeded in one of two ways: by the narrowing of blood vessels or by trauma to the vessels that service the bone.

As the blood flow is diminished, the cells begin to die from lack of nourishment. As the condition worsens, the bone grows weaker and more brittle until, eventually, it becomes so structurally unsound that it breaks, often into several pieces.

AVN is a progressive disease that worsens over time. It almost always affects the hip but can also be seen in the knees or shoulders.

AVN affects people with HIV at 58 times the rate seen in the general population and is associated, at least in part, with the chronic inflammation that accompanies long-term HIV infection.

Symptoms and Diagnosis of AVN

In the early stages of AVN, there may be few or no symptoms. As the disease progresses, there can be a growing pain in the groin and hip.

As AVN doesn't appear on a typical X-ray, diagnosis can often difficult. In fact, it is often mistaken for a simple muscle pain or arthritis.

Unless a magnetic resonance imaging (MRI) scan is performed, AVN can often go undiagnosed for years. Eventually, the pain can become so unbearable that mobility is restricted. Fractures are common as increasing amounts of bone begin to die, particularly in the weight-bearing joints.

Causes of AVN in People With HIV

AVN is a fairly common problem in people with HIV and is most often linked with the persistent inflammation seen with long-time infection. Over time, this inflammation causes the breakdown of cells and tissues throughout the body, resulting in a degenerative genetic process called premature senescence (premature aging). Scientists sometimes referred to the inflammatory reaction as "inflammaging."

As a result of this process, a person with HIV will typically experience aging-related conditions 10 to 15 years earlier than their non-infected counterparts. Among these aging-related conditions are bone and hip fractures typically seen in people 70 and over.

Other risk factors can contribute to AVN in people with HIV, including:

  • Smoking
  • Alcohol abuse
  • High cholesterol and triglycerides
  • Chronic pancreatitis
  • Coagulopathy (a bleeding disorder caused by the inability to clot)
  • Corticosteroid use

Treatment of AVN

Unfortunately, there is no treatment that can cure AVN. Narcotic and non-narcotic pain medications can be used relieve any associated pain. Medicines that decrease localized inflammation may also help.

There are surgical procedures that can restore blood flow to the affected area. However, in most cases, a  hip replacement is the only way to fully regain mobility once significant bone death has occurred.

With that being said, the early diagnosis and treatment of HIV are known to reduce the impact of chronic inflammation, lowering the risk of many long-term illnesses ​​by as much as 53 percent.

A Word From Verywell

If you have HIV and are experiencing hip or groin pain, tell your doctor irrespective of the severity. Early diagnosis of AVN affords you more treatment options, whether surgical or non-surgical, and can improve long-term outcome while preserving your mobility.

Sources:

The INSIGHT START Study Group. "Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection." New England Journal of Medicine. July 20, 2015; DOI: 10.1056/NEJMoa1506816.

Wilmes, D.; Docquier, P.; Belkhir, L. et al. "Avascular necrosis of femoral head in patients with human immunodeficiency virus 1 (HIV-1) infection." Journal of the International AIDS Society. 2012; 15(Suppl 4):18325.

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