Fracture management in HIV positive individuals: a systematic review

Abstract

Purpose: Human immunodeficiency virus (HIV) infection could potentially play an important role in the management of fractures as they have been shown to affect fracture healing and the post-operative risk of implant sepsis.Methods: A systematic review of the relevant literature was performed on PubMed and Scopus databases. Twenty-six studies were identified, critiqued and analysed accordingly. No randomised controlled trials were identified.Results: HIV positivity was not shown to influence an individual's risk of early wound infection in operatively managed closed fractures. Thank you for your kind comments on our unique systematic review. We have responded to the reviewers and made the changes suggested. Authors' response Many thanks for your comments. The suggested references however interesting, does not seem to cater to this population of interest. The suggested first article focusses on myocardial complications in those undergoing arthroplasty. The second suggested article main emphasis is on spinal trauma and does not refer to the HIV population. Thus we have decided not to go forth inserting these references and no further actions were taken. We do think that these articles are useful and may be included in a future study.Reviewer #2: This is a nice review paper suggesting the well-known fact that there is a place in HIV patients to surgical fixation of fractures.However the authors should: 1) Explain in the "Introduction" and in the "Discussion" the meaning of ART and the new development in this mode of treatment and describe the change in morbidity and mortality in HIV patients" in the last few years and the relation of this change to their findings Authors' response Many thanks for your comments. We agree that a further explanation on ART should be included to the reader. This was included in the "Introduction." Clarification on the morbidity and mortality reduction since the introduction of ART in HIV infected patients was also included. Regarding discussing the new developments in ART, this is a whole topic in itself and beyond the scope of this review. However, we are currently finalising a similar systematic review focusing on the effect of ART on bone metabolism and fracture healing which we will submit for consideration for publication in your journal soon. Authors' action Powered by Editorial Manager® and ProduXion Manager® from Aries Systems CorporationThe following changes have been made; The introduction of Anti-Retroviral Therapy (ART) in 1997 altered the course and nature of patients infected with HIV by increasing the duration of asymptomatic infection and increasing life expectancy [2,3]. ART is a combination of medication given to those affected with the disease. This suppresses the viral load and improves the patient immunological status [4]. A 50% reduction in morbidity and mortality has been reported in those with a CD4 T-cell count of >500cells/mm3 and have been started on ART promptly [5,6]. However, despite near normal life expectancy, there is little evidence to...

Fracture Healing in Patients With HIV in South Africa: A Prospective Cohort Study

“…There is little evidence surrounding the risk of delayed union and non-union following an open fracture in people with HIV in the current literature but non-union rates of between 10% and 43% have been reported in a small number of studies. 14 Contrary to previous research, this study demonstrated that HIV status does not appear to affect the clinical outcome of fracture healing and may potentially lower the risk of non-union. This could be explained by a number of factors, including direct and indirect immunological effects of HIV on bone, 28,29 and/or characteristics of the study population.…”

“…Previous studies had suggested non-union in 0-11% of fractures in HIV-positive individuals following surgical fixation of a fracture. 14 Antiretroviral therapy regimen, CD4 count, and viral load at baseline were also not associated with a significant risk of delayed union in the study population of participants with HIV. However, a greater number of ART naïve participants and more of those with a higher viral load developed delayed union and a much larger, appropriately powered, study is required to investigate this further.…”

Analysis of the surgical treatment of fracture in HIV positive patients: A clinical study

“…In a review of twenty-six patients, Wijesekera and colleagues suggested in open fractures managed with internal fixation, postoperative wound infection rates were significantly increased in HIV-positive population compared to HIV-negative controls. 13 …”

Infected nonunion of tibia

“…Routine tests reveal anemia, hypoproteinemia, and comorbidities. Serological marker testing for hepatitis B surface antigen,9 HIV,10 and hepatitis C11 is mandatory. Multiple transfusions and surgeries make these patients susceptible for viral infections.…”