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Fracture-related infections in HIV infected patients: A systematic review and meta-analysis

Luan Nieuwoudt1, Reitze N Rodseth2,3, Leonard Charles Marais4

  • 1Tumour, Sepsis & Reconstruction Unit, Grey's Hospital, Pietermaritzburg, 3201, KwaZulu-Natal, South Africa.

Journal of Orthopaedics
|February 20, 2020
PubMed
Abstract

Insights

Before antiretroviral therapy, HIV-positive patients had a higher risk of fracture-related infections (FRI). Post-therapy, this increased risk for FRI in HIV patients is no longer observed.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Public Health

Background:

  • Fracture-related infections (FRI) pose a significant challenge in orthopedic surgery.
  • The impact of HIV infection on FRI risk has been a subject of ongoing investigation.

Purpose of the Study:

  • To systematically review and meta-analyze the incidence of FRI in HIV-positive versus HIV-negative patients undergoing surgical management of closed and open fractures.
  • To compare FRI rates in different eras of HIV treatment.

Main Methods:

  • A comprehensive literature search was performed across major databases (MEDLINE, ProQuest, Web of Science, Cochrane Library, Scopus).
  • Eleven studies were included, focusing on the primary outcome of FRI development in patients with open and closed fractures.

Main Results:

  • Overall, HIV-positive patients showed a non-significant increase in FRI compared to HIV-negative patients.
  • A substantially higher risk (5.6 times) of FRI was observed in open fractures treated before the widespread use of antiretroviral therapy.
  • In the post-antiretroviral era (1997 onwards), no increased risk of FRI was found in HIV-positive patients for either open or closed fractures.

Conclusions:

  • Prior to antiretroviral therapy, HIV infection was associated with an elevated risk of fracture-related infections.
  • Current data suggests that in the post-antiretroviral era, HIV-infected patients do not exhibit an increased risk of FRI following fracture management.
Keywords:
AIDSChronic osteomyelitisFracture-related infectionHIVInfectionPost-operativePost-traumatic infectionSepsisSurgical site infection

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