A 10-Year-Old Boy, HIV Positive, Develops Progressive Weakness

George, Timothy; Grant, John A.; DeLeon, Guillermo; Darling, Crystal F.

doi:10.1159/000028798

Cited by 4 publications

(2 citation statements)

References 2 publications

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“…[20][21][22][23] Furthermore, most reports of spine surgery in HIV-positive patients do not pertain to degenerative spine conditions. 13,14,[24][25][26][27] As such, the need for greater investigation into the outcomes after surgery for LDD in HIV-positive patients is significant.…”

Section: Discussionmentioning

confidence: 99%

“…Contributing factors may include surgeon avoidance due to perceived increased risk of complications or viral transmission to surgeon or staff 20–23. Furthermore, most reports of spine surgery in HIV-positive patients do not pertain to degenerative spine conditions 13,14,24–27. As such, the need for greater investigation into the outcomes after surgery for LDD in HIV-positive patients is significant.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Outcomes of Human Immunodeficiency Virus–positive Patients Undergoing Lumbar Degenerative Surgery

Varshneya

Wadhwa

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Objective: The objective of this study was to determine the postoperative complications and quality outcomes of the human immunodeficiency virus (HIV)-positive patients undergoing surgical management for lumbar degenerative disease (LDD).Methods: This study identified patients with who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether they were HIV positive at the time of surgery. Multivariate regression was utilized to reduce the confounding of baseline covariates. Patients who underwent 3 or more levels of surgical correction were under the age of 18 years, or those with any prior history of trauma or tumor were excluded from this study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined.Results: A total of 120,167 patients underwent primary lumbar degenerative surgery, of which 309 (0.26%) were HIV positive. In multivariate regression analysis, the HIV-positive cohort was more likely to be readmitted at 30 days [odds ratio (OR) = 1.9, 95% confidence interval (CI): 1.2-2.8], 60 days (OR = 1.7, 95% CI: 1.2-2.5), and 90 days (OR = 1.5, 95% CI: 1.0-2.2). The HIVpositive cohort was also more likely to experience any postoperative complication (OR = 1.7, 95% CI: 1.2-2.3). Of the major drivers identified, HIV-positive patients had significantly greater odds of cerebrovascular disease and postoperative neurological complications (OR = 3.8, 95% CI: 1.8-6.9) and acute kidney injury (OR = 3.4, 95% CI: 1.3-7.1). Costs of index hospitalization were not significantly different between the 2 cohorts

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Human Immunodeficiency Virus–positive Patients Undergoing Lumbar Degenerative Surgery

Varshneya

Wadhwa

et al. 2021

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

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Disparities in Rates of Spine Surgery for Degenerative Spine Disease Between HIV-Infected and Uninfected Veterans

King

Gordon²,

Perkal³

et al. 2012

Spine

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Study Design Retrospective analysis of nationwide Veterans Health Administration (VA) clinical and administrative data. Objective Examine the association between HIV infection and the rate of spine surgery for degenerative spine disease. Summary of Background Data Combination anti-retroviral therapy (cART) has prolonged survival in patients with HIV/AIDS, increasing the prevalence of chronic conditions such as degenerative spine disease that may require spine surgery. Methods We studied all HIV infected patients under care in the VA from 1996–2008 (n=40,038) and uninfected comparator patients (n=79,039) matched on age, gender, race, year, and geographic region. The primary outcome was spine surgery for degenerative spine disease defined by ICD-9 procedure and diagnosis codes. We used a multivariate Poisson regression to model spine surgery rates by HIV infection status, adjusting for factors that might affect suitability for surgery (demographics, year, comorbidities, body mass index, cART, and laboratory values). Results Two-hundred twenty eight HIV infected and 784 uninfected patients underwent spine surgery for degenerative spine disease during 700,731 patient-years of follow-up (1.44 surgeries per 1,000 patient-years). The most common procedures were spinal decompression (50%), and decompression and fusion (33%); the most common surgical sites were the lumbosacral (50%), and cervical (40%) spine. Adjusted rates of surgery were lower for HIV infected patients (0.86 per 1,000 patient-years of follow-up) than for uninfected patients (1.41 per 1,000 patient-years; IRR 0.61, 95% CI: 0.51, 0.74, P<0.001). Among HIV infected patients, there was a trend towards lower rates of spine surgery in patients with detectable viral loads levels (IRR 0.76, 95% CI: 0.55, 1.05, P=0.099). Conclusion In the VA, HIV infected patients experience significantly reduced rates of surgery for degenerative spine disease. Possible explanations include disease prevalence, emphasis on treatment of non-spine HIV-related symptoms, surgical referral patterns, impact of HIV on surgery risk-benefit ratio, patient preferences, and surgeon bias.

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