Femoral Neck Fractures in HIV-Positive Patients: Analysis of 10 Years Short-Term Post-operative Complications

Urgent Focus on the Surgical Risks of People Living With HIV: A Systematic Review and Meta-Analysis

With the widespread promotion and application of antiretroviral therapy in clinical practice, people living with HIV (PLWH) have the potential to live as long as non-HIV people and the probability of surgery for PLWH has been increasing dramatically. However, the overall postoperative outcome and risk are still unclear. We performed comprehensive and methodical searches in PubMed, Embase, and Web of Science without date and language restrictions. Study outcomes included: (1) cure rate, (2) mortality, (3) reoperation rate, (4) incidence of any postoperative complications, (5) length of stay, and (6) operation duration. NOS scores were employed to evaluate bias risk, while publication bias was assessed using funnel plots and Egger tests. Review Manager version 5.4.1, R version 4.4.1, and Stata version 14.0 were employed to determine quantitative analysis, considering a significance level of p < 0.05. A total of 50 studies were included, involving 54 565 PLWH undergoing surgical treatment. Synthesis analysis showed that the mortality (OR = 1.70, 95% CI: 1.58-1.83, p < 0.00001), reoperation rate (OR = 1.78, 95% CI: 1.36-2.34, p < 0.00001), complication rate (OR = 1.56, 95% CI: 1.26-1.95, p < 0.00001), LOS (OR = 1.63, 95% CI: 1.28-1.99, p < 0.00001), and operation time (OR = 7.37, 95% CI: 1.14-13.59, p = 0.02) were increased in PLWH. However, there was no significant difference in the cure rate compared to the control group (OR = 1.27, 95% CI: 0.90-1.79, p = 0.18). Subgroup analysis showed that complication rates increased again in orthopedic (OR = 1.65, 95% CI: 1.34-2.05, p < 0.00001) and general surgery (OR = 1.72, 95% CI: 1.08-2.74, p = 0.02). However, the type of procedure, publication quality, study type, and patient origin were not sources of complication rate heterogeneity. Meta-regression showed that CD4 count had no effect on complication rate, but the anti-retroviral therapy rate had 34.89% explanatory power. There is an increased risk of postoperative death, reoperation, complications, and prolonged hospital stay and surgical duration in PLWH. However, conducting extensive prospective studies across multiple centers is crucial to validate these findings.

HIV and fracture: Risk, assessment and intervention

OBJECTIVES

With management of comorbidity in people living with HIV (PLWH) a key component of clinical care, early loss of bone integrity and clinical fracture are recognized as important issues. This review aims to describe the epidemiology of fracture in PLWH, as well as summarizing the relative balance of factors that contribute to fracture. We also aim to describe fracture risk assessment and interventional strategies to modify the risk of fracture in this population.

RESULTS

Data from recent meta-analyses show that PLWH have significantly more fractures than the general population, with men and injecting drug users at higher risk. Modifiable factors that contribute to fracture risk in this cohort include body mass index (BMI), drug use, concurrent medications, frailty, and hepatitis C virus infection. Relating to antiretroviral therapy, current or ever tenofovir exposure has been identified as predictive of fracture but not cumulative use, and a potentially modest protective effect of efavirenz has been observed. Fracture Risk Assessment Tool scores underestimate fracture risk in PLWH with improved accuracy when HIV is considered a cause of secondary osteoporosis and bone mineral density (BMD) included.

CONCLUSION

Early consideration of risk, prompting evaluation of modifiable risk factors, frailty and falls risk with bone density imaging and prompt intervention may avert fracture in PLWH. Guidance on screening and lifestyle modification is available in international guidelines. Bisphosphonates are safe and effective in PLWH, with limited data for other agents.

Fracture-related wound infections following surgical treatment of fractures in HIV-positive and HIV-negative patients: A meta-analysis

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.