Surgical Outcomes in HIV-Positive Patients
Summary
Surgical management of HIV-positive patients has evolved substantially since the widespread adoption of combination antiretroviral therapy. Improved immune function, reflected by higher CD4+ T-cell counts and suppressed viral loads, has extended life expectancy and increased demand for surgical interventions in this population. Nonetheless, concerns persist regarding perioperative infection risk, wound healing and bone union. Recent investigations spanning orthopaedic, spinal and general surgical procedures indicate that well-controlled HIV infection, coupled with meticulous patient optimisation, can yield outcomes comparable to those in HIV-negative cohorts. Key factors influencing postoperative recovery include immune status, nutritional reserves, comorbid metabolic conditions and adherence to perioperative antiretroviral protocols. Orthopaedic techniques such as intramedullary nailing for long-bone fractures, total joint arthroplasty for degenerative or osteonecrotic hip and knee disease, and complex spinal fusion are among the procedures extensively studied. These data carry practical implications for risk stratification, multidisciplinary care pathways and the development of universal guidelines to ensure safe and effective surgery for this growing global patient population.
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Surgical Outcomes in HIV-Positive Patients publication trend
The graph below shows the total number of articles in surgical outcomes in hiv-positive patients across all publications each year (not limited to Nature Index journals).
Technical terms
CD4+ T-cell count: A measure of immune competence, indicating the number of helper T lymphocytes per cubic millimetre of blood.
Viral load: The quantity of HIV RNA in plasma, used to assess effectiveness of antiretroviral therapy.
Intramedullary nailing: A surgical technique in which a metal rod is inserted into the marrow canal of a long bone to stabilise fractures.
Total joint arthroplasty: Surgical replacement of a diseased joint, typically the hip or knee, with prosthetic components.
Delayed union and nonunion: Delayed union refers to slower-than-normal fracture healing, while nonunion denotes failure of a fracture to heal without further intervention.
Perioperative optimisation: The process of improving a patient’s medical, nutritional and functional status before surgery to reduce postoperative complications.
Propensity score matching: A statistical technique used in observational studies to balance groups on measured covariates and reduce bias.
References
- Fracture Healing in Patients With HIV in South Africa: A Prospective Cohort Study. JAIDS Journal of Acquired Immune Deficiency Syndromes (2021).
- Optimizing Total Joint Arthroplasty for Patients Living With Human Immunodeficiency Virus. Cureus (2022).
- The Impact of Asymptomatic Human Immunodeficiency Virus-Positive Disease Status on Inpatient Complications Following Spine Surgery: A Propensity Score-Matched Analysis. Journal of Clinical Medicine (2023).
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