Protease inhibitors and avascular necrosis: a systematic review and meta-analysis.


Journal Article (Review)

Avascular necrosis (AVN) is a pathological process associated with many medical conditions, including human immunodeficiency virus (HIV) infection. Whether or not the use of protease inhibitors (PIs) confers additional risk for AVN to HIV-infected patients is controversial. Previous epidemiological studies showed an increased risk of AVN among PI users, but these studies did not have enough power to achieve statistical significance. A meta-analysis of case-control studies reporting the odds ratios (ORs) of AVN among HIV-infected patients who were exposed to PIs compared with non-exposed patients was conducted. Pooled ORs and 95% confidence intervals (CIs) were calculated using a fixed-effect Mantel-Haenszel analysis. Four case-control studies were identified and included for data analysis. The meta-analysis demonstrated an increased odds of AVN in participants exposed to PIs, with an OR of 2.09 (95% CI 1.01-4.31; P=0.05). The statistical heterogeneity of this meta-analysis was determined not to be important, with an I(2) of 0%. The meta-analysis revealed a statistically significant increased odds of AVN among PI-exposed, HIV-infected patients. Physician should be aware of this association as it may help guide potential therapeutic options, particularly for patients with other classic risk factors for AVN.

Full Text

Cited Authors

  • Permpalung, N; Ungprasert, P; Summachiwakij, S; Leeaphorn, N; Knight, EL

Published Date

  • August 2014

Published In

Volume / Issue

  • 44 / 2

Start / End Page

  • 93 - 95

PubMed ID

  • 24726526

Pubmed Central ID

  • 24726526

Electronic International Standard Serial Number (EISSN)

  • 1872-7913

Digital Object Identifier (DOI)

  • 10.1016/j.ijantimicag.2014.02.011


  • eng

Conference Location

  • Netherlands