Implant orthopaedic surgery in HIV asymptomatic carriers: Management and early outcome

Bahebeck, Jean; Eone, Daniel Handy; Nonga, Bernadette Ngo; Kingue, T. Ndjie; Sosso, Maurice Aurélien

doi:10.1016/j.injury.2008.12.012

Cited by 31 publications

(23 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This feeling was echoed by numerous other study groups [5][6][7][8][9]. Even this year, Randelli also called for removal of all implants in HIV positive patients [6]. However, a 1-year follow-up of 26 such cases by our own group identified no late implant sepsis [10].…”

Section: Introductionmentioning

confidence: 70%

“…Brijlall [4] later described a number of such cases, warning that this had the potential to alter clinical practice in relation to selection of patients for internal fracture fixation, and suggesting that removal of all such implants in HIV-positive individuals should be considered. This feeling was echoed by numerous other study groups [5][6][7][8][9]. Even this year, Randelli also called for removal of all implants in HIV positive patients [6].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Late implant sepsis after fracture surgery in HIV positive patients

Graham

Bates

Mkandawire

et al. 2015

Injury

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Late implant sepsis after fracture surgery in HIV positive patients

Graham

Bates

Mkandawire

et al. 2015

Injury

View full text Add to dashboard Cite

“…Bahebeck et al [34] from Cameroon, demonstrated an infection rate of 5% (n=74) in his HIV-positive study group compared to 1% (n=572) in the HIV-negative control group. This study prospectively analysed a cohort of patients with closed injuries that underwent surgery for fresh fractures, non-union, malunion, aseptic necrosis, and osteoarthritis.…”

Section: Closed Fracturesmentioning

confidence: 85%

“…This same definition of an ASEPSIS score of greater than 10 was used by the Malawi group [31]. However, the definition used in the other studies was not consistent [32,24,[33][34][35][36][37].…”

Section: Closed Fracturesmentioning

confidence: 99%

Fracture management in HIV positive individuals: a systematic review

Wijesekera

Graham

Lalloo

et al. 2016

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

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...

show abstract

“…Those few studies that examined death often were underpowered to perform multivariate analyses. Some reports continued to show increased complications 22,23,44–50 and death 44,46,49 in patients with HIV infection, but others documented declining rates of surgical complications and deaths in the HIV infection group that rivaled those experienced by uninfected individuals across many surgical specialties including orthopedics, 51–57 cardiovascular surgery, 13,58–61 bariatric surgery, 62 transplant surgery, 16,24,63 obstetrics, 10,11,64 urologic surgery, 65 neurosurgery, 66 and general surgery. 12,14,15 …”

Section: Discussionmentioning

confidence: 99%

Thirty-Day Postoperative Mortality Among Individuals With HIV Infection Receiving Antiretroviral Therapy and Procedure-Matched, Uninfected Comparators

et al. 2015

View full text Add to dashboard Cite

IMPORTANCE Antiretroviral therapy (ART) has converted human immunodeficiency virus (HIV) infection into a chronic condition, and patients now undergo a variety of surgical procedures, but current surgical outcomes are inadequately characterized. OBJECTIVE To compare 30-day postoperative mortality in patients with HIV infection receiving ART with the rates in uninfected individuals. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of nationwide electronic medical record data from the US Veterans Health Administration Healthcare System, October 1, 1996, to September 30, 2010. Common inpatient surgical procedures were grouped using the Healthcare Cost and Utilization Project Clinical Classification System to match HIV-infected and uninfected patients in a 1:2 ratio. Data on 1641 patients with HIV infection receiving combination ART who were undergoing inpatient surgery were compared with data on 3282 procedure-matched, uninfected comparators. Poisson regression models of 30-day postoperative mortality were adjusted for procedure year, age, Charlson Comorbidity Index score, hemoglobin level, albumin level, HIV infection, CD4 cell count, and HIV-1 RNA level. MAIN OUTCOMES AND MEASURES All-cause 30-day postoperative mortality. RESULTS The most common procedures in both groups were cholecystectomy (10.5%), hip arthroplasty (10.5%), spine surgery (9.8%), herniorrhaphy (7.4%), and coronary artery bypass grafting (7.0%). In patients with HIV infection, CD4 cell distributions were 80.0% with 200/µL or more, 16.3% with 50/µL to 199/µL, and 3.7% with less than 50/µL; 74.1% of patients with HIV infection had undetectable HIV-1 RNA. Human immunodeficiency virus infection was associated with higher 30-day postoperative mortality compared with the mortality in uninfected patients (3.4% [56 patients]) vs 1.6% [53]); incidence rate ratio [IRR], 2.11; 95% CI, 1.41–3.17; P < .001). CD4 cell count was inversely associated with mortality, but HIV-1 RNA provided no additional information. After adjustment, patients with HIV infection had increased mortality compared with uninfected patients at all CD4 cell count strata (≥500/µL: IRR, 1.92; 95% CI, 1.02–3.60; P = .04; 200–499/µL: IRR, 1.89; 95% CI, 1.20–2.98; P = .01; 50–199/µL: IRR, 2.66; 95% CI, 1.29–5.47; P = .01; and <50/µL: IRR, 6.21; 95% CI, 3.55–10.85; P < .001). Hypoalbuminemia (IRR, 4.35; 95% CI, 2.78–6.81; P < .001) and age in decades (IRR, 1.47; 95% CI, 1.23–1.76; P < .001) were also strongly associated with mortality. CONCLUSIONS AND RELEVANCE Current postoperative mortality rates among individuals with HIV infection who are receiving ART are low and are influenced as much by hypoalbuminemia and age as by CD4 cell status. Human immunodeficiency virus infection and CD4 cell count are only 2 of many factors associated with surgical outcomes that should be incorporated into surgical decision making.

show abstract

Implant orthopaedic surgery in HIV asymptomatic carriers: Management and early outcome

Cited by 31 publications

References 7 publications

Late implant sepsis after fracture surgery in HIV positive patients

Late implant sepsis after fracture surgery in HIV positive patients

Fracture management in HIV positive individuals: a systematic review

Thirty-Day Postoperative Mortality Among Individuals With HIV Infection Receiving Antiretroviral Therapy and Procedure-Matched, Uninfected Comparators

Contact Info

Product

Resources

About