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HIV-related immune weakening, chronic inflammation, and compromised bone health raise the risk of osteomyelitis. This review examines the complex pathogenesis linking immune dysfunction, microbial invasion, and resulting bone damage, and outlines why diagnosis is frequently delayed in HIV—highlighting limits of symptoms, imaging, and microbiological confirmation.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/osteomyelitis-in-hiv-pathogenesis-challenges-and-therapeutic-strategies/439838/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/osteomyelitis-in-hiv-pathogenesis-challenges-and-therapeutic-strategies/439838.png","ImageObject",300,407,{"name":92,"@type":93},"McQueen","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is osteomyelitis more common or severe in individuals with HIV?","Question",{"text":112,"@type":113},"HIV causes immunosuppression and alters inflammatory responses, increasing vulnerability to infections and promoting bone damage. Chronic inflammation further supports bone remodeling imbalance that can raise susceptibility.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What makes diagnosing osteomyelitis in HIV patients difficult?",{"text":117,"@type":113},"Symptoms are often nonspecific and overlap with other HIV-related bone conditions, leading to delayed recognition. Microbiological confirmation can also be challenging when atypical pathogens are involved.",{"name":119,"@type":110,"acceptedAnswer":120},"Which diagnostic and treatment challenges are emphasized in the review?",{"text":121,"@type":113},"Imaging such as MRI and CT helps identify bone involvement, but timely diagnosis remains difficult. 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Goryacheva, PhDb  \nAbstract  \nOsteomyelitis, a severe bone infection, presents a significant challenge in individuals living with HIV due to immunosuppression and an increased susceptibility to opportunistic pathogens. HIV infection leads to a weakened immune system, which, in conjunction with chronic inflammation and compromised bone health, increases the risk of developing osteomyelitis. This review delves into the complex pathogenesis of osteomyelitis in HIV patients, exploring the interplay between immune dysfunction, microbial invasion, and the subsequent bone damage that occurs. The diagnosis of osteomyelitis in HIV-infected individuals is often delayed due to nonspecific symptoms and the challenge of distinguishing it from other conditions. Imaging techniques, such as MRI and CT scans, are essential for identifying bone involvement, but microbiological confirmation can be challenging due to atypical pathogens. As a result, timely intervention becomes difficult and often leads to more severe infections and complications. This review highlights these diagnostic challenges and emphasizes the need for a more efficient and accurate approach to detection. Keywords: bone infection, HIV, immunosuppression, inflammation, osteomyelitis  \nIntroduction  \nOsteomyelitis, a severe infection of the bone, is a significant clinical concern, particularly in immunocompromised individuals, including those living with HIV. It is typically caused by bacterial, fungal, or mycobacterial pathogens, leading to inflammation and bone destruction, and, if left untreated, can result in systemic infection and long-term disability. In HIV-infected individuals, the risk of developing osteomyelitis is increased due to immune suppression, altered inflammatory responses, and frequent exposure to opportunistic infections. The management of osteomyelitis in this population presents unique challenges, both in terms of diagnosis and treatment. The intersection of HIV-induced immunosuppression and the heightened risk of bone infections require a detailed understanding of the pathogenesis of osteomyelitis in these patients[1,2] . The pathogenesis of osteomyelitis in HIV patients is multifaceted, involving complex interactions between the host immune system, bone remodeling, and infectious agents. HIV-induced depletion of CD4+ T cells compromises the body’s ability to fight infections effectively, making HIV patients more  \naDepartment of Biomedical and Laboratory Science, Africa University, Mutare, Zimbabwe and bDepartment of Polyclinic Therapy, Perm State Meical University named afterAcademician E.A. Wagner, Ministry of Health of the Russian Federation. 26 Petropavlovskaya St., Perm, Russian Federation  \nSponsorships or competing interests that may be relevant to content are disclosed at the end of this article.  \n*Corresponding author. Address: Mutare, Department of biomedical and laboratory science, Africa University, zimbabwe. Tel.: +2348037369912.  \n[E-mail: emmanuelobeagu@yahoo.com](E-mail: emmanuelobeagu@yahoo.com) (E. I. Obeagu).  \nCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  \nAnnals of Medicine & Surgery (2026) 88:459–469  \nReceived 31 March 2025; Accepted 4 November 2025  \nPublished online 18 November 2025  \n[http://dx.doi.org/10.1097/MS9.0000000000004326](http://dx.doi.org/10.1097/MS9.0000000000004326)  \nHIGHLIGHTS  \n● Increased susceptibility: HIV-induced immunosuppression heightens vulnerability to osteomyelitis, often caused by opportunistic pathogens.  \n● Atypical pathogens: Uncommon organisms, including mycobacteria and fungi, complicate diagnosis and treatment.  \n● Diagnost","cbCaibmMbLdVjGHn","https://ap.wps.com/l/cbCaibmMbLdVjGHn","pdf",421949,11,"English","# Highlights\n## Increased susceptibility\n## Atypical pathogens\n## Diagnostic challenges\n## Therapeutic complexity\n## Surgical considerations\n# Abstract\n# Introduction","[{\"question\":\"Why is osteomyelitis more common or severe in individuals with HIV?\",\"answer\":\"HIV causes immunosuppression and alters inflammatory responses, increasing vulnerability to infections and promoting bone damage. Chronic inflammation further supports bone remodeling imbalance that can raise susceptibility.\"},{\"question\":\"What makes diagnosing osteomyelitis in HIV patients difficult?\",\"answer\":\"Symptoms are often nonspecific and overlap with other HIV-related bone conditions, leading to delayed recognition. Microbiological confirmation can also be challenging when atypical pathogens are involved.\"},{\"question\":\"Which diagnostic and treatment challenges are emphasized in the review?\",\"answer\":\"Imaging such as MRI and CT helps identify bone involvement, but timely diagnosis remains difficult. Treatment is complicated by diagnostic uncertainty and potential drug interactions between antiretroviral therapy and antibiotics, and advanced cases may need surgery with poor wound healing.\"}]","Osteomyelitis in HIV pathogenesis, challenges, and therapeutic strategies | PDF",1790690375,28]