Fracture healing in patients with HIV in South Africa: a prospective cohort study

Graham, S. M., Maqungo, S., Laubscher, M., Ferreira, N., Held, M., Harrison, W. J., Simpson, A. H., MacPherson, P. and Lalloo, D. G. (2021) Fracture healing in patients with HIV in South Africa: a prospective cohort study. JAIDS: Journal of Acquired Immune Deficiency Syndromes, 87(5), pp. 1214-1220. (doi: 10.1097/QAI.0000000000002720) (PMID:33990496) (PMCID:PMC8263144)

Abstract

Background: HIV reduces bone mineral density, mineralization, and turnover and may impair fracture healing. Setting: This prospective cohort study in South Africa investigated whether HIV infection was associated with impaired fracture healing after trauma. Methods: All adults with acute tibia and femur fractures who underwent intermedullary (IM) nailing for fracture fixation between September 2017 and December 2018, at 2 tertiary hospitals, were followed up for a minimum of 12 months postoperatively. The primary outcome was delayed bone union at 6 months (defined by the radiological union scoring system for the tibia score <9), and the secondary outcome was nonunion (defined as radiological union scoring system for the tibia score <9) at 9 months. Multivariable logistic regression models were constructed to investigate the associations between HIV status and impaired fracture healing. Results: In total, 358 participants, who underwent 395 IM nailings, were enrolled in the study and followed up for 12 months. Seventy-one of the 358 (19.8%) participants were HIV-positive [83/395 (21%) IM nailings]. HIV was not associated with delayed fracture healing after IM nailing of the tibia or femur (multivariable odds ratio: 1.06; 95% confidence interval: 0.50 to 2.22). HIV-positive participants had a statistically significant lower odds ratio of nonunion compared with HIV-negative participants (multivariable odds ratio: 0.17; 95% confidence interval: 0.01 to 0.92). Conclusions: Fractures sustained in HIV-positive individuals can undergo surgical fixation as effectively as those in HIV-negative individuals, with no increased risk of delayed union or nonunion.

• Item Type: Articles
• Additional Information: Supported by a Wellcome Trust Research and Training PhD Fellowship and support from the AOUK Foundation.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Graham, S. M., Maqungo, S., Laubscher, M., Ferreira, N., Held, M., Harrison, W. J., Simpson, A. H., MacPherson, P., and Lalloo, D. G.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: JAIDS: Journal of Acquired Immune Deficiency Syndromes
• Publisher: Lippincott, Williams & Wilkins
• ISSN: 1525-4135
• ISSN (Online): 1944-7884
• Published Online: 10 May 2021
• Copyright Holders: Copyright © 2021 The Author(s)
• First Published: First published in Journal of Acquired Immune Deficiency Syndrome 87(5):p 1214-1220
• Publisher Policy: Reproduced under a Creative Commons licence