Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

Carol A Lin,W David Hardy,Robert L Rettig,Antonio Hernandez Conte,James Mirocha,Phillip H Behrens,Andrew G Rudikoff,Heidi L Kiziah,Guy Paiement

doi:10.1186/s13018-020-01827-y

Abstract

BackgroundThe impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear. The goals of this study were to assess the rate of perioperative infection at a large tertiary care referral center and to identify risk factors in HIV+ patients undergoing total hip arthroplasty (THA).MethodsThis study was a prospective, observational study at a single medical center from 2000–2017. Patients who were HIV+ and underwent THA were followed from the preoperative assessment period, through surgery and for a 2-year follow-up period.ResultsSixteen of 144 HIV+ patients (11%) undergoing THA developed perioperative surgical site infections. Fourteen patients (10%) required revision THA within a range of 12 to 97 days after the initial surgery. The patients’ mean age was 49.6 ± 4.5 years, and the most common diagnosis prompting THA was osteonecrosis (96%). Patients who developed SSI had a lower waist-hip ratio (0.86 vs. 0.93, p = 0.047), lower high density lipoprotein cholesterol (45.8 vs. 52.5, p = 0.015) and were more likely to have post-traumatic arthritis (12.5% vs. 0%, p = 0.008). Logistic regression analysis demonstrated that current alcohol use and higher waist-hip ratio were significant protectors against infection (p < 0.05). No other demographic, medical, immunologic parameters, or specific HAART regimens were associated with perioperative infection.ConclusionsImmunologic status as measured by CD4+ cell count, HIV viral load, and medical therapy do not appear to influence the development of SSI in HIV+ patients undergoing THA. Metabolic factors and post-traumatic arthritis may influence the increased rate of infection in HIV+ patients following THA.

Highlights

The impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear
Since the introduction of modern highly active antiretroviral therapy (HAART) in 1996, there has been a dramatic improvement in the survival of those who adhere to therapy [1,2,3,4,5]
Patients who were enrolled in a prospective, observational study of HIV and cardiac risk at an urban academic medical center with an annual volume of >1000 total joint arthroplasty procedures per year were screened for inclusion

Summary

Introduction

The impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear. The goals of this study were to assess the rate of perioperative infection at a large tertiary care referral center and to identify risk factors in HIV+ patients undergoing total hip arthroplasty (THA). Studies focusing upon this issue were conducted in the pre-HAART era [14], and additional studies were performed during the early HAART era, often including patients with hemophilia or intravenous drug use [15,16,17] These studies were limited by small sample size [11] or lack of clinical follow-up [12, 18]. With the advent of newer, more effective HAART coupled with longer periods of medication adherence, the relationship between HIV and surgical site infection (SSI) is still unclear and can complicated by other viral infections or coexisting diseases [19, 20]

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