
2025 Clinician Corner - Aseptic osteonecrosis of the jaw in a patient with HIV on tenofovir
Overview
Abstract
The introduction of antiretroviral therapy has improved survival of people with HIV (PWH). However, morbidities that accompany aging and the added burden of antiretroviral therapy on bone metabolism are growing concerns with treatment and improved survival. While a few studies have been done among PWH examining bone density and risk of fractures, the association with osteonecrosis is less studied. PWH have been reported to have osteonecrosis involving the hip joint, shoulder joint, knees, and ankles. Most cases of osteonecrosis associated with HIV infection involve the femoral head, but the involvement of the jaw is rare. We report a case of osteonecrosis of the jaw in a patient who has had HIV for more than 10 years.
Keywords: AIDS; bone density; HIV; osteonecrosis; tenofovir
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Faculty credentials/disclosure
The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.
Process
Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit. You must achieve 100% on the quiz with unlimited attempts available.
- By completing this process, you are attesting that you have read the journal article.
Expiration date:
Credit eligibility for this article is set to expire on July 1, 2026.
Learning Objectives
After completing the article, the learner should be able to:
- Identify the clinical presentation and the associated risk factors for the development of osteonecrosis of the jaw in patients with HIV.
- Describe the pathophysiology behind the development of osteonecrosis in patients with HIV, the impact of HIV-related immune dysfunction, and the use of antiretroviral therapy in bone health.
- Recognize the importance of oral hygiene, as well as treatment of dental and periodontal disease in patients with HIV.
Key Points
- Osteonecrosis has been associated with HIV/AIDS; therefore, it is an important differential to be considered in people with HIV presenting with pathological fracture.
- Elimination of active dental and periodontal disease should be considered in people with HIV, as the jaw is more prone to osteonecrosis, with a high remodeling rate.
Faculty
- Shraddha Bhattarai, MD - Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
- Shashank Bhattarai, MD - Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
- Lavanya Dondapati, MD - Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
- Eric Macapinlac, MD - Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
- Victor Kolade, MD - Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
Corresponding author: Shraddha Bhattarai, MD, Guthrie Robert Packer Hospital, 1 Guthrie Sq, Sayre, PA 18840 (e-mail: shraddhabhattarai13@gmail.com; X/Twitter: @shraddha140013)
Accreditation
Accreditation
The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Designation
AMA PRA Category 1 Credit™
The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ABS CC
Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
ABIM MOC
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
Available Credit
- 1.00 American Board of Internal Medicine (ABIM) MOC Part 2Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
- 1.00 American Board of Surgery (ABS) Accredited CMESuccessful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
- 1.00 AMA PRA Category 1 Credit™The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
- 1.00 Attendance