Abstract
Aim: The aim was to assess the seroprevalence of Human Immunodeficiency Virus (HIV) in non-haemophilic patients undergoing primary Total Joint Arthroplasty (TJA) at an academic hospital in South Africa.Methods: A retrospective review of all Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) patients from January 2017 to December 2018 was conducted. All patients awaiting TJA were offered HIV screening and their demographic data were recorded. Consenting patients were tested or the refusal of testing was documented. The CD4+ T-cell count (CD4+) and viral load (VL) was measured for all HIV-positive patients and newly diagnosed patients were initiated on Highly Active Antiretroviral Treatment (HAART).Results: We included 1007 patients in the study. The TJA population HIV seroprevalence was 10.7% (n = 108). The seroprevalence for THA was 14.9% (n = 78) and that for TKA was 6.2% (n = 30). There were 93 patients (9.2%) who refused screening. There were 12 (15.4%) and 3 patients (10%) that were newly diagnosed in the THA and TKA seropositive populations, respectively. The average CD4+ for THA and TKA was 569 cells/mm3 (105–1320) and 691 cells/mm3 (98–1406), respectively. The VL was undetectable in 75.9% (n = 82) of HIV-positive patients. Overall 12 HIV-positive patients (11.12%) had CD4+ <200 cells/mm3, 8 of these patients (66%) were newly diagnosed. The average age of the seropositive population was 58 ± 6.5 years and 66 ± 8.5 years for THA and TKA, respectively (p = 0.03). Femoral head osteonecrosis was the underlying pathology for 65.38% (n = 51) of seropositive patients for THA.Conclusion: The seroprevalence of HIV in patients undergoing THA in our South African institution is greater than the seroprevalence in the general population. The seroprevalence of HIV in THA is significantly greater than that in TKA. This may reflect the association between HIV, HAART and hip joint degeneration. Our findings draw attention to the significant burden HIV has on TJA.
Highlights
Total Joint Arthroplasty (TJA) is a commonly performed orthopaedic procedure with advances in implants and surgical techniques producing excellent outcomes in the majority of patients [1]
Subjects were excluded if the Human Immunodeficiency Virus (HIV) status was unknown with no documented evidence of refusal to screen, which may indicate that Voluntary Counselling and Testing (VCT) was not offered
Neither blood test results of HIV status nor evidence of refusal to screen could be traced in 45 patients (4.28%) and these patients were excluded from the study
Summary
Total Joint Arthroplasty (TJA) is a commonly performed orthopaedic procedure with advances in implants and surgical techniques producing excellent outcomes in the majority of patients [1]. The demand for TJA is high with over 1.4 million and 131 005 operations performed annually in the United States of America (USA) [2] and Canada [3], respectively [4]. South Africa accounts for the most people living with HIV (7.2 million) worldwide, and the highest cost burden of US$ 2 073 272 539 for patient management [7]. This is further compounded by the highest rate of new infections with 270 000 new diagnoses reported in 2017 alone [7]. There is still no known cure for HIV and patient management is centered around disease control with Highly Active Anti-retroviral Treatment (HAART) [11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
