HIV+ for 18 years and about 2 years ago I had a clot to lung and found out I had factor five. I also started Truvada, prezista and norvir and diagnosed with AVN in both hips after 1 1/2 years of starting them. I have been researching and find AVN is not so uncommon for others like me? Should I ask to change regimen? Doctor wants me to stay on. I recently had chest paid and I stopped for a month, started back on and feel the chest pain come back although xrays and heart tests show nothing. So frustrated. I have had lactic acidosis in early 2000 from bad regimen and went without drugs for 10 years.

The risk for avascular necrosis of the hip appears modestly increased in HIV+ person. I am unaware of any data demonstrating that any of the more modern HIV regimens-such as your regimen-is linked to a further increase in risk. Use of steroids, high triglycerides, alcohol use, hypertension, clotting disorders, and other conditions are linked to increased risk for avascular necrosis. For some of my HIV+ patients with avascular necrosis there was no clear contributing factor identified. I cannot with any confidence recommend a regimen with a proven lower risk for avascular necrosis nor would stopping your HIV meds likely improve the situation either (stopping meds has been linked to increased risk of a variety of serious health condition beyond AIDS).I have had patients do well after hip surgery. You situation sounds frustrating and complicated-I wish I could provide a simpler effective answer to your good question(s). KH