Coinfection of HIV and hepatitis C increases complication rates after total joint arthroplasty

Abstract

Introduction: As advances in efficacy of human immunodeficiency virus (HIV) and hepatitis-C virus (HCV) anti-viral medications increase, patients are able to maintain higher quality of lives than ever before. While these patients live longer lives, the unique patient population of those co-infected with both HIV and HCV increases. As these older patients seek orthopaedic care, it is important to understand their unique outcome profile. The purpose of this study was to evaluate the complication rate after total joint arthroplasty (TJA) in patients with HIV and HCV coinfection compared with patients with HIV or HCV only. Methods: A retrospective review of patients undergoing primary total joint arthroplasty (TJA) at our urban, academic hospital between April 2016 and April 2019 was conducted. Patients were stratified into three groups according to viral status: HIV only, HCV only, or HIV and HCV coinfection. Baseline demographics, intravenous drug (IV) use, surgery type, CD4+ count, follow-up and complications were analysed. Results: Of the 133 patients included in the study, 28 had HIV, 88 had HCV and 17 were coinfected with both HIV and HCV. Coinfected patients were more likely to have a lower BMI (p < 0.039) and a history of IV drug use (p < 0.018) compared to patients with either HIV or HCV only. Coinfected patients had a higher complication rate (41%) than both HIV only (7%; p < 0.001) and HCV only (12.5%; p < 0.001) patients. Discussion: Patients coinfected with HIV and HCV undergoing TJA have a higher complication rate than patients with either infection alone. As this unique population of coinfected patients continues to expand, increasingly they will be under the care of arthroplasty surgeons. Improved awareness and understanding of the baseline demographic differences between these patients is paramount. Recognition of the increased complication rates grants the opportunity to improve their orthopaedic care through preoperative and multidisciplinary management.

Complications and surgical treatment after pathological fracture associated to HIV secondary disease. A case report

“…In HIV patients, comorbidities and HAART play a fundamental role in the evolution of joint pathology [ 2 ]. Besides, the associated fracture risk increases in patients with HIV and HCV coinfection in parallel to the risk of secondary infection, as seen in our patient [ 8 ].…”

Postoperative outcomes of total elbow replacement in haemophilic elbow arthropathy: A systematic review

“…involving 50 patients reported an overall complication rate of 22% and an infection rate of 6% in HIV infected patients, with a conclusion that HAART therapy reduces overall infection rates in total joint (hip/knee) arthroplasty. On the other hand, a study involving 133 patients having total hip/knee arthroplasty by Fang et al 33 . showed that coinfection with HIV and HCV led to a 41% complication rate compared with isolated HIV (7%) or HCV (12.5%) infection.…”

“…The study by Jacob et al 32 involving 50 patients reported an overall complication rate of 22% and an infection rate of 6% in HIV infected patients, with a conclusion that HAART therapy reduces overall infection rates in total joint (hip/knee) arthroplasty. On the other hand, a study involving 133 patients having total hip/knee arthroplasty by Fang et al 33 showed that coinfection with HIV and HCV led to a 41% complication rate compared with isolated HIV (7%) or HCV (12.5%) infection. Theoretically, this may also apply to TER, and it is therefore important for patients undergoing elective TER to have HAART treatment and suppressed HIV viral loads with CD4 count optimization preoperatively.…”

Total Joint Arthroplasty Should Not Be Delayed in Hepatitis C Patients After Successful Treatment Achieving a Sustained Viral Load

“…Coinfection with HIV and HCV has been shown to be associated with increased postoperative complications including PJI, with HCV driving the risk [ [31] , [32] , [33] ]. We did not appreciate in our study population any significant difference in HIV rates in patients with PVL and UVL, while HIV coinfection was not a risk factor for PJI.…”