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Chen H, Zhu Y, Chen Q. Fracture-related wound infections following surgical treatment of fractures in HIV-positive and HIV-negative patients: A meta-analysis. Int Wound J 2024; 21:e14336. [PMID: 37705307 PMCID: PMC10784629 DOI: 10.1111/iwj.14336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 09/15/2023] Open
Abstract
The meta-analysis aims to evaluate and compare fracture-associated wound infections (FAWIs) following surgical treatment of fractures in human immunodeficiency virus (HIV)-positive and HIV-negative patients. Examinations comparing HIV-negative to HIV-negative for fracture was among the meta-analysis from various languages that met the inclusion criteria. Using dichotomous random or fixed models, the results of these investigations were examined, and the Odds ratio (OR) with 95% confidence intervals was computed (CIs). 14 examinations from 1991 to 2023 were recruited for the current analysis including 3528 personals with fractures. HIV-positive had significantly higher FAWI before antiretroviral (OR, 3.59; 95% CI, 2.01-6.41, p < 0.001) compared to HIV-negative personals with fractures. However, no significant difference was found between HIV-positive and HIV-negative in FAWI after antiretroviral (OR, 0.58; 95% CI, 0.30-1.12, p = 0.10) in personals with fractures. The examined data revealed that HIV-positive had significantly higher FAWI before antiretroviral, however, no significant difference was found in FAWI after antiretroviral compared to HIV-negative personals with fractures. Nevertheless, caution should be exercised while interacting with its values since some of the chosen examinations were found with a low sample size and a low number of examinations were found for the comparisons studied for the meta-analysis.
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Affiliation(s)
- Huizhen Chen
- Department of EndocrinologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Yuxia Zhu
- Infection Management OfficeHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Qiu Chen
- Department of EndocrinologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
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Zhang Y, Zhao CS, Chen JM, Zhang Q. Efficacy of single-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis. AIDS Res Ther 2022; 19:53. [PMID: 36419079 PMCID: PMC9682655 DOI: 10.1186/s12981-022-00478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We aimed to observe the clinical effect of single-stage posterior surgery on HIV-positive patients with thoracolumbar tuberculosis. METHODS From October 2015 to October 2019, 13 HIV-positive patients with thoracolumbar tuberculosis who underwent single-stage posterior surgery were retrospectively analyzed (observation group), and 13 HIV-negative patients with thoracolumbar tuberculosis who were matched with the gender, age, operative site, and surgical approach during the same period were selected as the control group. Postoperative complications, hemoglobin, albumin, CD4+T lymphocyte count, operative site, operative time, and blood loss were recorded between the two groups. The clinical efficacy was evaluated by the visual analog scale (VAS), American Spinal Injury Association (ASIA) scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphotic angle, correction rate of kyphosis, angle loss, and bone graft fusion time. RESULTS In the observation group, 7 patients had postoperative complications, including 1 patient with cerebrospinal fluid leakage, 1 patient with nerve root irritation, 1 patient with an opportunistic infection, and 4 with delayed wound healing. In the control group, 2 patients developed postoperative complications, including 1 with nerve root irritation and 1 with delayed wound healing. There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). CD4+T lymphocyte count, hemoglobin, and albumin in HIV-positive patients with postoperative complications were statistically different from those without postoperative complications (P all < 0.05). No tuberculosis recurrence was found at the last follow-up, ESR and CRP returned to normal, and there were no statistically significant differences in bone graft fusion time, VAS score, ASIA scale, correction rate of kyphosis, and angle loss between two groups (P all > 0.05). CONCLUSION Single-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis could achieve satisfactory clinical efficacy through comprehensive preoperative evaluation, standardized perioperative antiviral and anti-tuberculosis treatments, and prevention of postoperative complications.
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Affiliation(s)
- Yao Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No. 8, Jingshun East Street, Chaoyang District, Beijing, 100015 China
| | - Chang-song Zhao
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No. 8, Jingshun East Street, Chaoyang District, Beijing, 100015 China
| | - Jia-min Chen
- grid.24696.3f0000 0004 0369 153XDepartment of Pathology, Beijing Ditan Hospital, Capital Medical University, No. 8, Jingshun East Street, Chaoyang District, Beijing, 100015 China
| | - Qiang Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No. 8, Jingshun East Street, Chaoyang District, Beijing, 100015 China
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Sun S, Xu B, Zhang Q, Zhao CS, Ma R, He J, Zhang Y. The Early Results of Vertebral Pathological Compression Fracture of Extra- nodal Lymphoma with HIV-positive Patients Treated by Percutaneous Kyphoplasty. Curr HIV Res 2021; 18:248-257. [PMID: 32386494 DOI: 10.2174/1570162x18666200510010207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vertebral pathological compression fracture involving extra-nodal lymphoma impacts negatively on the quality of life of HIV-positive patients. The choice of a safe and effective approach to palliative care in this condition remains a challenge. OBJECTIVE The purpose of this study was to investigate the safety and efficacy of percutaneous kyphoplasty (PKP) in the treatment of vertebral pathological compression fracture of extra-nodal lymphoma in HIV-positive patients. METHODS A retrospective analysis, from January 2016 to August 2019, was performed on 7 HIVpositive patients, 3 males and 4 females, with extra-nodal lymphoma with a vertebral pathological compression fracture. The patients were treated using percutaneous kyphoplasty in our hospital. Preoperative assessment of the patients was conducted regarding their hematological profile, biochemical indicators, liver and kidney function, blood coagulation function, CD4+T lymphocyte count and viral load. Subsequently, the patients were placed on highly active antiretroviral therapy (HAART) and rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) regimen. Besides, antibiotics, nutritional support and immune-modulating drugs were also administered, rationally. Postoperatively, the height of the anterior edge of the injured vertebrae, Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) values were evaluated. Patients were also monitored for any complications related to the operation. RESULTS The average CD4+T cell count for the patients was 164 (range 114 ~247 / ul), while the viral load was 26,269 (range 5,765 ~82,321 copies/ul). All patients received nutritional and immune support and registered significant improvements in the levels of ALB and Hb (P<0.05). In all cases, the operation was uneventful with neither cement leakage nor toxic reactions observed. Similarly, no opportunistic infections, other complications or deaths were reported. The height of the anterior vertebral body and the ODI score of the injured vertebrae were significantly improved immediately after surgery (P<0.05). Compared to the preoperative VAS (7.71±1.11), postoperative values were significantly reduced immediately after surgery (3.85±0.90) and at 2 weeks, 1 month and 6 months post-surgery: 2.71±0.76, 3.29±1.11, and 4.00±0.82, respectively (P<0.01). CONCLUSION Supported with appropriate perioperative treatment measures, PKP is safe and effective in the treatment of pathological vertebral compression fracture due to extra-nodal lymphoma in HIV-positive patients.
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Affiliation(s)
- Sheng Sun
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Biao Xu
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Qiang Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Chang-Song Zhao
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Rui Ma
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Jie He
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
| | - Yao Zhang
- Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing 100015, China
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A tale of three pandemics: Shining a light on a hidden problem. Surgeon 2021; 20:231-236. [PMID: 34167911 PMCID: PMC9300845 DOI: 10.1016/j.surge.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022]
Abstract
An “epidemic” is an event in which a disease, infectious or non-infectious, is actively spreading within a population and designated area. The term “pandemic” is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”. The global response to the COVID-19 pandemic has not been seen since the outbreak of Human Immunodeficiency Virus in the early eighties. But there is another unseen pandemic running alongside the current COVID-19 pandemic, which affects a vast number of people, crossing international boundaries and occurring in every single country worldwide. The pandemic of traumatic injuries. Traumatic injuries account for 11% of the current Global Burden of Disease, resulting in nearly 5 million deaths annually and is the third-leading cause of death worldwide. For every trauma-related death, it is estimated that up to 50 people sustain permanent or temporary disabilities. Furthermore, traumatic injuries occur at disproportionately higher rates in low- and middle-income countries, with approximately 90% of injuries and more than 90% of global deaths from injury occurring these countries. Injuries are increasing worldwide, crossing international boundaries and affecting a large number of people, in the same manner Human Immunodeficiency Virus did in the 1980's and COVID-19 is today. The tremendous global effort to tackle the COVID-19 and Human Immunodeficiency Virus pandemics has occurred whilst ignoring the comparable pandemic of injury. Without change and future engagement with policy makers and international donors this disparity is likely to continue.
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Brennan C, Laubscher M, Maqungo S, Graham SM. Bibliometric analysis of research on the effects of human immunodeficiency virus in orthopaedic and trauma surgery. World J Orthop 2021; 12:169-177. [PMID: 33816143 PMCID: PMC7995343 DOI: 10.5312/wjo.v12.i3.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/12/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is little research investigating how human immunodeficiency virus (HIV) affects outcomes in orthopaedic surgery. With advances in treatment, HIV has become a chronic health problem and the chance of orthopaedic surgeons encountering it in clinical practice is increasing.
AIM To ascertain the quantity and quality of peer-reviewed publications in orthopaedic journals about HIV.
METHODS A search of the Web of Science database was carried out, identifying any articles relating to HIV published in orthopaedic journals. These were assessed for geographic origin and level of evidence.
RESULTS Of 48.7% of orthopaedic journals listed on the Web of Science database had published articles relating to HIV. There were 168 articles about HIV in orthopaedic journals with only 40.5% (n = 68) published in the time frame we analysed (January 2007 to September 2017). Very few articles came from low-income countries and any articles published from that setting were collaborations. All of the articles were low level of evidence.
CONCLUSION There is a need for more high level orthopaedic and trauma research investigating the effects of HIV, particularly research from low-income countries, where higher level research will help to guide improvements in their treatment of its musculoskeletal manifestations and complications.
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Affiliation(s)
- Ciaran Brennan
- Department of Orthopaedics, Royal Cornwall Hospital, Truro TR13LQ, United Kingdom
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Sithombo Maqungo
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Simon Matthew Graham
- Orthopaedic Research Unit, University of Cape Town, Cape Town 7925, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town 7925, South Africa
- Institute of Population Health Sciences, University of Liverpool, Liverpool L97AL, United Kingdom
- Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospitals Trust, Liverpool L97AL, United Kingdom
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L97AL, United Kingdom
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Nieuwoudt L, Rodseth RN, Marais LC. Fracture-related infections in HIV infected patients: A systematic review and meta-analysis. J Orthop 2020; 18:248-254. [PMID: 32071513 DOI: 10.1016/j.jor.2020.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/19/2020] [Indexed: 02/02/2023] Open
Abstract
Aim To conduct a systematic review and meta-analysis comparing the incidence of fracture-related infections (FRI) following surgical management of closed and open fractures in HIV-positive and HIV-negative patients. Methods A systematic literature search was conducted using MEDLINE, ProQuest, Web of Science, The Cochrane Library and Scopus. Our own files and reference lists of identified key articles were also searched. We included studies where the primary outcome was the development of FRI in patients with open and closed fractures. Results Eleven studies were included for data synthesis. HIV-positive patients had a non-significant increase in FRI when compared to HIV-negative patients (in open and closed fractures combined). Open fractures treated in the pre-antiretroviral era had a 5.6 times greater risk for developing a FRI. In the post-antiretroviral era (1997 onwards) HIV-positive patients did not have a greater risk of FRI than HIV-negative patients for both open and closed fractures. The small retrospective natures of these studies, together with the heterogeneous outcome definitions used, are limitations to this study. Conclusion While there are few large prospective studies, the available data suggests that before the introduction antiretroviral therapy HIV infection was associated with a greater risk of FRI. In the post-antiretroviral era HIV infected patients did not show an increased risk of FRI.
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Affiliation(s)
- Luan Nieuwoudt
- Tumour, Sepsis & Reconstruction Unit, Grey's Hospital, Pietermaritzburg, 3201, KwaZulu-Natal, South Africa
| | - Reitze N Rodseth
- Department Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa.,Jones, Bhagwan and Partners, Pietermaritzburg, South Africa
| | - Leonard Charles Marais
- Department Orthopaedics, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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Tatara AM, Kontoyiannis DP, Mikos AG. Drug delivery and tissue engineering to promote wound healing in the immunocompromised host: Current challenges and future directions. Adv Drug Deliv Rev 2018; 129:319-329. [PMID: 29221962 PMCID: PMC5988908 DOI: 10.1016/j.addr.2017.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/23/2017] [Accepted: 12/04/2017] [Indexed: 12/16/2022]
Abstract
As regenerative medicine matures as a field, more promising technologies are being translated from the benchtop to the clinic. However, many of these strategies are designed with otherwise healthy hosts in mind and validated in animal models without other co-morbidities. In reality, many of the patient populations benefiting from drug delivery and tissue engineering-based devices to enhance wound healing also have significant underlying immunodeficiency. Specifically, patients suffering from diabetes, malignancy, human immunodeficiency virus, post-organ transplantation, and other compromised states have significant pleotropic immune defects that affect wound healing. In this work, we review the role of different immune cells in the regenerative process, highlight the effect of several common immunocompromised states on wound healing, and discuss different drug delivery strategies for overcoming immunodeficiencies.
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Affiliation(s)
- Alexander M Tatara
- Medical Scientist Training Program, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States; Department of Bioengineering, Rice University, Houston, TX, United States.
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, United States.
| | - Antonios G Mikos
- Department of Bioengineering, Rice University, Houston, TX, United States.
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Kortram K, Bezstarosti H, Metsemakers WJ, Raschke MJ, Van Lieshout EM, Verhofstad MH. Risk factors for infectious complications after open fractures; a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2017; 41:1965-1982. [DOI: 10.1007/s00264-017-3556-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/23/2017] [Indexed: 01/20/2023]
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Hohmann E, Birkholtz F, Glatt V, Tetsworth K. The "Road to Union" protocol for the reconstruction of isolated complex high-energy tibial trauma. Injury 2017; 48:1211-1216. [PMID: 28351547 DOI: 10.1016/j.injury.2017.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The purpose of this study was to describe a standardized staged approach, "The Road to Union", for the reconstruction of isolated complex tibial trauma, both acute and chronic in nature. METHODS This retrospective study included all patients treated for complex tibial trauma at a specialized limb reconstruction centre, including acute open fracture as well as infected and aseptic non-unions. This standardized approach includes eight specific steps, employed in sequence. The time in external fixation (EFT), the external fixation index (EFI), and the distraction consolidation index (DCI) were the primary outcome measures. The relationship between EFI and DCI was assessed using Pearson's moment correlations. RESULTS Thirty-two patients with a mean age of 34.7±14.2years were included; 12 were treated for complex open tibial fractures with bone loss, 13 for infected non-unions, and 6 for aseptic non-union. The mean bone defect was 66±32mm. The total EFT was 42.5±14.8 weeks; the EFI measured 51.9±25.3 days/cm, and the DCI measured 48.3±21.4 days/cm. Union was achieved in 29 out of 32 patients (91%), and there was a strong and significant relationship between EFI and DCI (r=0.92, p=0.0001) measurements. Pin site infections were observed in 11 patients, and 3 patients had persistent non-union. Three patients underwent delayed amputations when reconstructive procedures were unable to achieve union. CONCLUSION The findings of this study demonstrate that a standardized staged treatment protocol of debridement, circular external fixation, soft-tissue management, distraction osteogenesis, and functional rehabilitation can result in a high rate of union in cases of complex tibial trauma, both acute and chronic in nature. LEVEL OF EVIDENCE Level IV; case series.
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Affiliation(s)
- Erik Hohmann
- School of Medicine, University of Pretoria, South Africa; Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates.
| | - Franz Birkholtz
- Walk-a-Mile Centre for Advanced Orthopaedics, Pretoria, South Africa; Department of Orthopaedic Surgery, University of Pretoria, Steve Biko Academic Hospital, South Africa
| | - Vaida Glatt
- Department of Orthopaedic Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; Department of Surgery, School of Medicine, University of Queensland, Australia; Queensland University of Technology, Orthopaedic Research Institute, Australia
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Fracture management in HIV positive individuals: a systematic review. INTERNATIONAL ORTHOPAEDICS 2016; 40:2429-2445. [PMID: 27655034 DOI: 10.1007/s00264-016-3285-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/25/2016] [Indexed: 12/18/2022]
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. The rate of pin track infection in open injuries managed with external fixators was low. However, in open injuries managed with internal fixation, early wound infection rates were increased in the HIV-positive population compared to HIV-negative individuals. Regarding late implant infection, in closed fractures there appeared to be no increased risk of infection but there is limited evidence for open injuries. Additionally, further evidence is needed to establish if the rate of union in both open and closed fractures are influenced by HIV status. CONCLUSION Overall, no evidence was found to suggest that surgical management of fractures in the HIV population should be avoided, and fixation of closed fractures in the HIV population appeared to be safe. The effect of anti-retroviral therapy is unclear and this should be further researched. However, based on the limited evidence, caution should be taken in the management of open fractures due to the potentially increased infection risk. The impact of anti-retroviral therapy on the outcomes of surgery needs further evaluation.
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Phakathi BP, Basson G, Karusseit VOL, Olorunju SAS, Mokoena T. The effect of HIV infection on the surgical, chemo- and radiotherapy management of breast cancer. A prospective cohort study. Int J Surg 2016; 34:109-115. [PMID: 27573692 DOI: 10.1016/j.ijsu.2016.08.520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 08/16/2016] [Accepted: 08/24/2016] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Breast cancer is the most common cancer of women in the world. Twenty-five percent of people living with the human immunodeficiency virus (HIV) reside in South Africa. The coincidence of breast cancer and HIV infection is therefore common in South Africa. There is a perception that systemic and local surgical complications are more common in HIV-infected patients, and that these patients tolerate chemo- and radiotherapy poorly. AIM The aim of the study was to determine the effect of HIV infection on the management of breast cancer by comparing HIV-infected to -noninfected patients. The outcomes of surgery and adjuvant/neoadjuvant therapy were examined in these groups. METHOD The study was performed at the Steve Biko Academic Hospital, Pretoria, South Africa, during 2009-2014. Patients scheduled for surgery for breast cancer were recruited prospectively and their HIV status was determined. All patients were managed according to standard guidelines for breast cancer. Patients were followed up for 30 days and local and systemic surgical complications documented. Completion or non-completion of courses of chemo- and radiotherapy, and reasons for non-completion were documented. HIV-infected and -noninfected patients respectively were grouped, and compared statistically. RESULTS One hundred and sixty patients (31 HIV-infected) were included. The frequency of surgical complications did not differ significantly between HIV-noninfected and infected patients (p = 0.08), more occurring in the HIV-noninfected patients. The risk ratio of HIV infection for surgical complications was 0.20 and the odds ratio 0.23. The completion of courses of chemo- and radiotherapy did not differ between the HIV-infected and -noninfected patients. Twenty-five of 27 HIV-infected patients (93%) and 100 of 113 HIV-noninfected patients (94%) completed their courses of chemotherapy (p = 0.68). Twelve of 14 HIV-infected patients (86%) and 40 of 41 HIV-noninfected patients (98%) completed their courses of radiotherapy (p = 0.16). CONCLUSION These results suggest that HIV-infected patients with breast cancer do not experience more treatment-related complications and can be treated according to standard guidelines.
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Affiliation(s)
- Boitumelo P Phakathi
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Gerhard Basson
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
| | - Victor O L Karusseit
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa.
| | - Steve A S Olorunju
- Biostatistics Unit, South African Medical Research Council, South Africa
| | - Taole Mokoena
- Department of Surgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
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Pretell-Mazzini J, Subhawong T, Hernandez VH, Campo R. HIV and Orthopaedics: Musculoskeletal Manifestations and Outcomes. J Bone Joint Surg Am 2016; 98:775-86. [PMID: 27147691 DOI: 10.2106/jbjs.15.00842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤Advances in combined antiretroviral therapy (cART) in recent years have transformed HIV infection into a chronic disease when treatment is available, increasing a patient's life expectancy and the chances that orthopaedic surgeons will encounter such patients in their clinical practice.➤Musculoskeletal manifestations in patients with HIV infection are common and sometimes are the initial presentation of the disease. Knowledge about neoplasms and associated conditions affecting muscle, bones, and joints is essential for successful management.➤Since the advent of cART, total joint arthroplasty has been shown to be a safe procedure; however, perioperative infection is still a small risk in patients with uncontrolled viral loads or CD4 counts of <400 cells/mm(3).➤With regard to trauma surgery, the rates of early and late infection around implants, as well as union rates, are comparable with those in the HIV-negative population; however, there is an increased risk of pulmonary, renal, and infectious or septic complications in the polytrauma setting.➤Factors such as CD4 count, nutritional status, cART therapy, viral load count, and other comorbidities (hemophilia, infection among intravenous drug users, etc.) should be considered when treating these patients in order to optimize their clinical outcomes.
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Affiliation(s)
- Juan Pretell-Mazzini
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
| | - Ty Subhawong
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
| | - Victor H Hernandez
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
| | - Rafael Campo
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
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Phaff M, Aird J, Rollinson PD. Delayed implants sepsis in HIV-positive patients following open fractures treated with orthopaedic implants. Injury 2015; 46:590-4. [PMID: 25650266 DOI: 10.1016/j.injury.2015.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/01/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND There has been concern that HIV-positive patients may be more susceptible to delayed infection (>1 month) after treatment of open fractures with orthopaedic implants. To date, the longest published follow-up for such patients is 6 months. AIM Long-term follow-up to identify rates of delayed implant sepsis in open fractures treated with internal fixation, in HIV positive patients and controls. METHODS Prospective observational study. Between March 2011 and April 2012, we attempted to contact all patients who were enrolled into a study looking at outcomes of open fractures treated with internal fixation between May 2008 and March 2009. Telephone questionnaires were used to screen for implant sepsis, and patients received clinical assessments at our research clinic. RESULTS Of 101 patients with in situ implants, we were able to follow 51 patients. Of the initial 33 HIV-positive patients, 13 were reassessed as part of this study. Only 1 of 13 HIV-positive patients developed delayed implant sepsis following a grade 3B open tibia fracture. Two of 23 HIV-negative patients developed delayed implant sepsis. CONCLUSION With an average follow-up period of 39 months (range=34-43 months), this is the longest follow-up period to evaluate HIV-positive patients with open fractures who received orthopaedic implants. Despite its limitations of poor follow up, it provides the strongest available evidence that in our setting HIV positive patients are not at higher risk of delayed sepsis, and we would not suggest routine removal of metal work in these patients.
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Affiliation(s)
- Martijn Phaff
- Department of Orthopedics, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
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Graham SM, Bates J, Mkandawire N, Harrison WJ. Late implant sepsis after fracture surgery in HIV positive patients. Injury 2015; 46:580-4. [PMID: 25601086 DOI: 10.1016/j.injury.2014.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 12/11/2014] [Indexed: 02/02/2023]
Abstract
A prospective cohort study was undertaken to assess the incidence of late-implant sepsis after internal fixation in HIV-positive patients. A total of 91 HIV-positive patients (67 males and 24 females) who underwent 103 procedures (111 implants) were followed up for a mean period of 27 months (range 12-66 months). No occurrences of late implant sepsis were found in 100 implants (94 procedures) in 82 patients at 27 months' follow-up (range 12-66 months). Nine patients (9 procedures, 9 implants) developed early infections within 6 weeks and were treated with antibiotics (6 patients), amputation (1 patient) or removal of metal work (2 patients). There was no evidence of subsequent late implant sepsis in any of these patients, at a mean follow-up of 25 months (range 12-52 months). This study demonstrates that it is safe to perform internal fixation in HIV-positive patients, with no observed increase risk of late implant sepsis. There is no indication to remove implants after fracture union, other than for the general clinical indications that may lead to removal of metal work in any patient.
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Affiliation(s)
- Simon Matthew Graham
- The Countess of Chester Hospital, Health Park, Chester, Cheshire, United Kingdom.
| | - Jes Bates
- Beit CURE International Hospital, Blantyre, Malawi; The Department of Surgery, College of Medicine University of Malawi, Malawi
| | - Nyengo Mkandawire
- Beit CURE International Hospital, Blantyre, Malawi; The Department of Surgery, College of Medicine University of Malawi, Malawi; School of Medicine, Faculty of Health Sciences, Flinders University, Australia
| | - William J Harrison
- The Countess of Chester Hospital, Health Park, Chester, Cheshire, United Kingdom; Beit CURE International Hospital, Blantyre, Malawi
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