Patients with HIV infection have a much higher rate of osteonecrosis than people in the general population. Risk factors include those seen with other conditions, plus some that are HIV-related.
Joints involved:
(1) hip (typically bilateral)
(2) knee
(3) ankles
(4) shoulder
(5) wrist
General risk factors:
(1) alcohol abuse
(2) corticosteroid therapy
(3) use of tobacco
(4) hypercoagulable state (antiphospholipid syndrome, other)
(5) hyperlipidemia
(6) chronic liver disease (hepatitis C, other)
(7) pancreatitis
HIV therapy related:
(1) megestrol acetate (used to treat cachexia)
(2) testosterone (used to treat male hypgonadism)
(3) protease inhibitors and other antiretroviral medications
HIV complications:
(1) lipodystrophy
(2) osteoporosis
Bone destruction tends to progress rapidly once the patient becomes symptomatic, so attempts at prevention should target patients before they develop bone involvement.
It would be interesting to see if patients with immune reactivation have a higher rate of osteonecrosis. Also, drug abuse (especially cocaine and methamphetamine) may be a risk factor.
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