Three men (aged 33, 44 and 45 years, CD4(+) T-cell nadir 86 cells/mm(3), 99 cells/mm(3) and 12 cells/mm(3), respectively) were admitted to the Department of
Infectious Diseases (Treichville Hospital, Abidjan, Côte d'Ivoire) for hip
pain and impaired mobility. Their last available CD4(+) T-cell counts were 243 cells/mm(3), 245 cells/mm(3) and 8 cells/mm(3), respectively. They had all received antiretroviral
therapy for >4 years, including
lopinavir/
ritonavir for >8 months. The other risk factors were hypertriglyceridaemia (n=3), smoking addiction (n=2), alcohol consumption (n=2) and
lipodystrophy (n=1). All three patients had heterozygous
haemoglobin AS sickle cell disease (percentage of haemoglobin S 41%, 45% and 50%, respectively). The diagnosis of avascular
osteonecrosis of the femoral head (unilateral n=2 and bilateral n=1) was documented by CT scan. Only one patient underwent surgical
arthroplasty. In resource-limited settings, avascular
osteonecrosis is uneasy to diagnose and unlikely to be appropriately treated. Physicians should be aware of its symptoms and risk factors, including
HIV infection and antiretroviral
therapy. Future studies should explore whether these risk factors might include
haemoglobin AS sickle cell disease, a common trait in the West African general population.