Serological risk factors for steroid-induced osteonecrosis in HIV men: a Bayesian case–control study

TL;DR

The study identifies elevated triglycerides, fibrinogen degradation products, and plasma thromboplastin antecedent as risk factors for steroid-induced osteonecrosis in HIV-positive men.

Contribution

The study introduces novel serum biomarkers for steroid-induced osteonecrosis in HIV patients using Bayesian analysis.

Findings

Triglycerides showed the strongest association with steroid-induced osteonecrosis (OR = 85.911).

Fibrinogen degradation products and plasma thromboplastin antecedent also significantly increased risk.

Prolonged prothrombin time was found to be protective against the condition.

Abstract

Human immunodeficiency virus (HIV)-infected individuals face diagnostic challenges for non-traumatic hormonal necrosis of femoral head (SONFH), as current imaging methods lack sensitivity/specificity and reliable biomarkers remain elusive. While coagulation disorders and dyslipidemia are known risk factors, evidence in HIV populations is limited.

This case–control study enrolled 48 HIV-positive males with SONFH and 50 controls from Beijing Ditan Hospital (2021–2025). We analyzed demographic, coagulation, inflammatory, and metabolic markers. Random forest selected top 20 predictors, followed by Bayesian regression to assess associations (reported as OR, 95% CI, posterior probabilities, and Bayes factors).

Triglycerides (TG) showed the strongest SONFH association (OR = 85.911, 95% CI: 4.733–3078.857; BF = 82.048). Fibrinogen degradation products (FDP) (OR = 6.968, 95% CI: 1.485–51.347; BF = 6.692) and plasma thromboplastin antecedent (PTA) (OR = 2.890, 95% CI: 1.131–11.146; BF = 2.046) also demonstrated significant risk associations. Prolonged prothrombin time (PT) was protective (OR = 0.008, 95% CI: 0.0002–0.234; BF = 37.897).

Elevated triglycerides, FDP, and PTA significantly increase the risk of SONFH in HIV patients, while prolonged PT may be protective. These serum markers could guide early intervention, though larger prospective studies are needed.

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