Non-traumatic Bilateral Lower Limb Fractures in Human Immunodeficiency Virus Positive Individuals on Long-Term Antiretroviral Therapy: Two Case Reports and Literature Review.

INTRODUCTION: It has been noticed that human immunodeficiency virus (HIV) infection and anti-retro viral (ART) therapy, both individually lead to bone metabolic disorders, and hence, such patients have an increased propensity for fractures following trivial trauma.

CASE REPORT: We present two cases, first a 52-year-old female with the right hip pain and inability to walk since 1 week following trivial trauma and associated dull pain in the left hip since 2 months ago. Radiographs revealed a right intertrochanteric fracture and a left unicortical fracture at level of lesser-trochanter. The patient was managed with closed proximal femoral nailing bilaterally and subsequently mobilized. Second, a 70- year-old female with bilateral leg pain and swelling following trivial trauma since 3 days. Radiographs revealed a distal one-third shaft tibia and fibula fracture bilaterally managed with closed nailing bilaterally and subsequently mobilized. Both patients had HIV infection since 10 and 14 years, respectively, and were on combination ART.

CONCLUSION: There should be a high index of suspicion to the possibility of fragility fractures in HIV affected patients on ART. Principles of fracture fixation and early mobilization should be followed.