Hip Pain and Fractures in People With HIV

Bone Related Disorder Increasingly Identified in People with Long Term HIV

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

In people with HIV these sort of symptoms can mean many things, some of which are related to infection and some of which are not.

One of the more common conditions being seen in HIV practices is a degenerative bone disorder of the hip known as avascular necrosis, or AVN.

What Is Avascular Necrosis (AVN)?

Avascular necrosis is a bone and vascular disease that is being diagnosed with greater frequency in people with long term HIV infection. Simply put, AVN (also known as osteonecrosis) is bone cell death caused by a diminished blood supply to the bones. Blood flow can often be interrupted by trauma to the blood vessels  or by narrowing of those same vessels.

As the blood flow is impeded, the cells begin to starved and die from lack of nourishment. As the condition worsens, the bone becomes weaker and more painful until eventually it becomes so structurally fragile that it can break, often into several pieces.

AVN is a progressive disease and tends to worsen over time. It most always affects the hip but can also be seen in the knees and shoulders.

When compared to the general population, AVN tends to affect people with HIV at a higher rate and is associated, in part, with the chronic inflammation that arises from long-term infection.

Symptoms and Diagnosis of AVN

In the early stages of AVN, there may be few or no symptoms at all. As the disease progresses, however, pain in the groin and hip is common.

Unfortunately, AVN doesn't appear on typical X-rays, making diagnosis all the more difficult. In fact, it is often mistaken for simple muscle pain or arthritis.

Unless an MRI (magnetic resonance imaging) is performed, AVN can often goes undiagnosed, with the patient getting increasing worse year after year. Eventually, the pain becomes so severe that walking can be seriously  affected. Fractures are common as more bone cells die, particularly in the weight-bearing joints.

What Causes AVN in People With HIV?

AVN is a fairly common problem in HIV-infected people and is most often associated with the persistent burden of chronic inflammation seen with long-time infection. Over time, this inflammation causes the breakdown of cells and tissues, resulting in degenerative genetic process called premature senescence (literally, premature aging).

As a result of this, a person with HIV will typically experience aging-related conditions 10-15 years earlier than their non-infected counterparts. Among these conditions are bone and hip fractures typically seen in people over the age of 70 and 80.

How Is AVN Treated?

Unfortunately, there is no treatment that can "cure" AVN. Narcotic and non-narcotic pain medications can be used short-term to treat symptoms. Medicines that decrease local inflammation can also help. There are surgical procedures that can be done to improve blood flow to the affected area. However, most often, surgical replacement of the affected hip is required to regain full mobility and function.

With that being said, the early diagnosis and treatment of HIV is known to reduce the impact of chronic inflammation, reducing the risk of non-HIV-related comorbidities by as much as 53% (including aging-related disorders commonly seen in people with long-term infection).

What Should I Do If I'm Experiencing Hip  Pain?

If you are having hip or groin pain, regardless of the severity, notify your doctor and ask about AVN and whether an MRI may be indicated for you. Early diagnosis does afford you more options and can improve long-term outcomes.


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.

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