A case−control study of elective hip surgery among HIV-infected patients: exposure to systemic glucocorticoids significantly increases the risk

Abstract

ObjectivesThis was a cross-sectional study with a nested case−control analysis among a cohort of HIV-infected adults aiming to explore the prevalence of and risk factors for elective hip surgery (total hip arthroplasty and resurfacing). MethodsCases were identified from the out-patient database of HIV-infected adults attending one tertiary hospital service. For each case, five controls from the same database matched by age, gender and ethnicity were identified. From the case notes, information about demographic factors, HIV factors and risk factors for hip surgery attributable to osteoarthritis or avascular necrosis (body mass index, lipids, alcohol, comorbidities and treatment with oral glucocorticoids) was extracted. ResultsAmong the cohort of 1900 HIV-infected out-patients, 13 cases (12 male) who had undergone hip surgery [0.7%; 95% confidence interval (CI) 0.3−1.1%] were identified, with a median age of 47 years. Eleven of the 13 cases (85%) were Caucasian and seven of the 13 were in stage 3 of HIV infection. Fewer of the cases were in the asymptomatic stage of infection compared with controls [odds ratio (OR) for stage 2 or 3 infection 4.0; 95% CI 0.8-18.5]. Ever having used oral glucocorticoids was highly significantly associated with elective hip surgery (OR 44.6; 95% CI 5.7-347.7). ConclusionsAmong this young cohort, the prevalence of elective hip surgery was 0.7%, with the median age at surgery being 47 years. Ever having been exposed to systemic glucocorticoids was highly significantly associated with elective hip surgery, suggesting that the principal mechanism underlying the need for surgery was avascular necrosis. There may be an increased need for elective hip surgery associated with HIV infection.

Sepsis risk factors associated with HIV-1 patients undergoing surgery

“…Therefore, the number of HIV-1-infected people is rapidly increasing. 6 HIV-1-infected people are prone to developing diseases that require surgical treatment, 7 such as appendicitis, liver cancer, and thighbone fracture. It is anticipated that there will be a corresponding increase in surgical workload for HIV-1-infected patients.…”

Assessment and management of musculoskeletal disorders among patients living with HIV

“…The principal risk factors are the same as those found in the general population, namely male gender, glucocorticoid use, excess alcohol and hypogonadism. Having observed that a significant number of patients with HIV had required total hip replacement (despite the median age of the cohort being 42 years), we undertook a case-control study, comparing the past exposures of the cases with a total hip replacement with 5 controls matched for age, gender and ethnicity [48]. Overwhelmingly the single most important risk factor for hip replacement, performed at a median age of 47 years, was exposure to systemic glucocorticoids (OR 44.6, p<0.0001), which had occurred in many cases at the time of their presentation with newly-diagnosed HIV and pneumocystis pneumonia.…”