Abstract
Objective:To evaluate the incidence of postoperative infection and fracture nonunion as well as the risk factors for postoperative infection in human immunodeficiency virus (HIV) positive patients.Methods:From May 2013 to March 2016, the HIV positive fracture patients treated surgically in orthopaedics department of our hospital were analyzed retrospectively, and fifty HIV negative fracture patients during the same period were selected as control. The clinical data of included patients were reviewed. The incidence of postoperative infection and fracture nonunion were compared between the two groups, and the risk factors for postoperative infection in HIV positive patients were evaluated.Results:The incidence of poor wound healing and incision infection in HIV positive group was higher than that in HIV negative group, but there were no significant differences between the two groups (p>0.05). Multivariable regression analysis demonstrated that HIV clinical category (p<0.05), CD4+T-lymphocyte category (p<0.01) and open fracture (p<0.05) were independent risk factors for postoperative wound infections, but age, gender, operation time, incision type, emergency operation, albumin and lymphocyte count were not (p>0.05). There was no significant difference in the rate of nonunion between the two groups (p>0.05).Conclusion:The incision can be healed, and fracture can be united normally in most of HIV positive patients with fracture, and postoperative wound infections were significantly associated with HIV clinical category, CD4+T-lymphocyte category and open fracture.
Highlights
Fifteen patients were excluded because of failing to meet the inclusion criteria, and fifty-four patients were included in human immunodeficiency virus (HIV) positive group
We focused on the evaluation of the incidence of postoperative infection and fracture nonunion as well as the risk factors for postoperative infection in fracture patients with HIV positivity, to clarify the controversial viewpoints, help surgeons better understand the issues
We found the incidence of incision infection in HIV positive group was higher, but there was no significant difference between the two groups, demonstrating that HIV positivity does not significantly increase the incidence of postoperative infection
Summary
Acquired immune deficiency syndrome (AIDS), arising from human immunodeficiency virus (HIV) infection, is one of the largest pandemics of the modern age.[1,2] In China, there were 4.34 hundred thousand persons infected with HIV, and the newly diagnosed cases were 0.7 hundred thousand in 2013.3 HIV-positive subjects may encounter opportunistic infections and malignancies, because of cellular immunological, humoral and nonspecific deficiencies.[4,5] At the same time, highly active antiretroviral therapy, which has been widely used and transformed HIV infection to a chronic, manageable condition, results in the increase of life expectancy of HIV/AIDS patients as well as the number of HIV-positive patients undergoing orthopaedic surgeries.[1]Pak J Med Sci November - December 2017 Vol 33 No 6 www.pjms.com.pk 1449Many clinical studies have been published to report the clinical outcomes of orthopaedic surgeries in HIV-positive patients. Some authors suggest that HIV-positive patients have higher rates of wound infection and nonunion than HIV negative patients after internal fixation.[1,6] in a study of 42 HIV-positive patients, Hao[7] suggests that HIV infection does not correlate with a higher rate of postoperative infection and fracture nonunion. Li advocates that the wound in HIV positive patients can be normally healed and no infection occur in most of patients.[3] In addition, some authors suggest that implant sepsis may occur after internal fixation, demonstrating that removal of implants in HIV-positive individuals should be considered,[5,8] but in another study of 91 HIV-positive patients, Graham concluded that it was safe to perform internal fixation and no increased risk of implant sepsis was detected.[9] Apparently, controversies are common
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