Effects of human immunodeficiency virus status on trauma outcomes: a review of the national trauma database

The prevalence of human immunodeficiency virus (HIV) is disproportionately elevated in trauma patients. Although HIV traditionally has been associated with poorer outcomes among the critically ill, recent evidence suggests that the outcomes of surgical patients have improved with the greater use of antiretroviral regimens. The purpose of this study was to utilize the National Trauma Data Bank (NTDB) to examine the impact of HIV on surgical outcomes in a large group of trauma patients.

We identified all patients for whom HIV status at time of admission was recorded. Results were stratified by age and Injury Severity Score. Our primary outcome was death. Secondary outcomes were length of hospital stay (LOS), length of intensive care unit (ICU) stay, duration of mechanical ventilation, and complications. Data were analyzed using Student t-tests or chi-square analysis, as appropriate.

The overall mortality rates were not significantly different in the HIV-positive and HIV-negative groups. Mortality rates remained similar in the two groups even when stratifying by ISS and age, with the exception of those patients who were 65 years or older. The HIV-positive patients had significantly longer LOS (7.6 vs. 5.6 days), shorter duration of mechanical ventilation (6.3 vs. 8.3 days), and no difference in length of ICU stay. The HIV-positive patients were significantly more likely to develop pneumonia, bacteremia, or wound infection.

These findings are consistent with those of recent smaller studies that demonstrated no significant difference in the mortality rate for patients with HIV. Although mortality rates are similar, HIV-positive patients are more likely to develop certain infectious complications and to require a longer LOS. Infection with HIV remains a major public health issue in the U.S. and internationally, and further research is necessary to explore the relation between HIV status and trauma outcomes, particularly with regard to the possible effects of antiretroviral treatment and individual immune status.