The incidence of the human immunodeficiency virus in injured patients in Lusaka

Abstract

Patients may present with pathology that is not directly related to their primary complaint. The possibility of the presence of an infecting agent may not be considered and precautions that should be taken may be inappropriately forsaken. A multispeciality study is being undertaken at the University of Zambia to assess the influence of the human immunodeficiency virus (HIV) on the presentation, treatment and outcome of surgical pathology. This study examines the HIV status of 100 patients presenting through the Accident Department with long bone fractures. Assessment using the World Health Organization (WHO) clinical staging system for HIV disease has been compared with the patient's response to the potential immunological challenge and HIV serological status. Thirty-two per cent of adults in the age range 16–55 years were seropositive for HIV but this rose to 50 per cent in those aged between 21 and 40 years. The majority of patients were male, but both sexes had similar patterns of serological status. All patients were in WHO stage 0, 1 or 2 but assessment with the WHO clinical criteria alone led to a high level of diagnostic inaccuracy. Clinical assessment of 18 patients suggested freedom from HIV influence but their serum was seropositive on ELISA testing. The absolute lymphocyte count was below 2000 cells/mm 3 in patients found to be seropositive and with disease of clincial stage 1 or 2.