Orthopaedic and trauma surgery in HIV positive patients

Infection with HIV leads to a gradual depletion of CD4 cells. HIV patients may present with a multitude of musculoskeletal conditions caused either by HIV infection itself or its treatment with highly active anti retroviral therapy (HAART). However, some musculoskeletal conditions like avascular necrosis of the femoral head are caused by a combination of both HIV infection and its treatment with HAART.HIV patients who need elective orthopaedic operations such as arthroplasty should have these procedures delayed until their general condition is optimized. This includes improving their albumin levels and CD4 counts before surgery.HIV also affects the presentation, management and prognosis of trauma patients. Seropositive patients with closed fractures achieve good outcomes after internal fixation, even if they suffer from significant immune depletion. HIV positive patients with open fractures have a worse outcome compared to HIV negative patients. HIV disease negatively affects wound, and probably fracture, healing.