Human Immunodeficiency Virus and Total Joint Arthroplasty: The Risk for Infection Is Reduced

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Virology

Background:

• Highly active antiretroviral therapy (HAART) has improved human immunodeficiency virus (HIV) patient longevity.
• HIV and HAART are associated with bone density issues, increasing the need for total joint arthroplasty (TJA).
• Periprosthetic joint infection (PJI) is a significant complication following TJA.

Purpose of the Study:

• To investigate the impact of modern HIV treatments on PJI rates after TJA.
• To compare PJI rates in HIV-infected patients with and without hemophilia.
• To assess the influence of HAART on PJI incidence.

Main Methods:

• A systematic review of 25 studies involving 722 TJAs.
• Data extraction on PJI rates in HIV-infected patients (with/without hemophilia) undergoing primary TJA.
• Analysis of HAART administration at the time of arthroplasty.

Main Results:

• PJI rates were 2.28% for HIV-only patients and 10.98% for HIV and hemophilia patients (P < .0001).
• Hemophilia was associated with a 5.28 odds ratio for PJI.
• HAART was linked to a significant reduction in overall infections (odds ratio, 0.12).

Conclusions:

• HIV-infected patients without hemophilia exhibit lower PJI rates post-TJA compared to those with hemophilia.
• HAART treatment and management of comorbidities appear to decrease PJI rates in HIV patients undergoing TJA.