Editors: Tornetta, Paul; Einhorn, Thomas A.; Damron, Timothy A.
Title: Oncology and Basic Science, 7th Edition
Copyright ©2008 Lippincott Williams & Wilkins
> Table of Contents > Section
IV – Basic Science > 27 – Infectious Disorders of Bone and Joint
> 27.4 – Viral Disorders
IV – Basic Science > 27 – Infectious Disorders of Bone and Joint
> 27.4 – Viral Disorders
27.4
Viral Disorders
Human Immunodeficiency Virus Infection
The human immunodeficiency virus (HIV) pandemic has
infected 56 million persons worldwide, including 20 million who have
already died. An estimated 1.1 million persons in the United States
have been infected with HIV. In the 3 years following the introduction
of highly active antiretroviral therapy (HAART), mortality, AIDS,
AIDS-defining diagnoses, and hospitalizations all decreased 60% to 80%.
Despite the absence of a cure, the natural history of the disease has
radically changed.
infected 56 million persons worldwide, including 20 million who have
already died. An estimated 1.1 million persons in the United States
have been infected with HIV. In the 3 years following the introduction
of highly active antiretroviral therapy (HAART), mortality, AIDS,
AIDS-defining diagnoses, and hospitalizations all decreased 60% to 80%.
Despite the absence of a cure, the natural history of the disease has
radically changed.
Surgical Complications and Outcomes
-
Osteonecrosis and avascular necrosis
-
Associated with HIV-positive patients but may be related to the medical treatment
-
Femoral head most common site
-
-
No prospective data are available on surgical morbidity and mortality.
-
Most clinical studies do not demonstrate
an increased incidence of early postoperative complications in
asymptomatic HIV-positive patients compared to the HIV-negative group. -
Most orthopaedic studies do not show an
increased incidence of early complications in symptomatic HIV-positive
patients with CD4 counts >200 undergoing elective procedures.
-
-
Risk of infectious complications
following emergent surgery is consistently higher in those with AIDS;
incidence of late prosthetic implant infection may be somewhat higher,
especially in hemophiliacs.-
The experience reported in these studies may not be relevant to patients receiving current regimens of antiretroviral therapy.
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Viral Transmission from Musculoskeletal Allografts
Hepatitis B virus, hepatitis C virus, and HIV can be
transmitted through musculoskeletal allografts. A blood transfusion is
more likely to transmit a viral disease than a bone allograft.
Fresh-frozen, unprocessed bone appears to carry a higher risk of
transmission.
transmitted through musculoskeletal allografts. A blood transfusion is
more likely to transmit a viral disease than a bone allograft.
Fresh-frozen, unprocessed bone appears to carry a higher risk of
transmission.
Suggested Reading
Harrison WJ. HIV/AIDS in trauma and orthopaedic surgery. J Bone Joint Surg [Br] 2005;87(9):1178-1181.
Zalavras
CG, Gupta N, Patzakis MJ, et al. Microbiology of osteomyelitis in
patients infected with the human immunodeficiency virus. Clin Orthop Rel Res 2005;439:97-100.
CG, Gupta N, Patzakis MJ, et al. Microbiology of osteomyelitis in
patients infected with the human immunodeficiency virus. Clin Orthop Rel Res 2005;439:97-100.