HIV seroprevalence and its effect on outcome of moderate to severe burn injuries: A Ugandan experience

Abstract

BackgroundHIV infection in a patient with burn injuries complicates the care of both the patient and the treating burn team. This study was conducted to establish the prevalence of HIV among burn patients in our setting and to compare the outcome of these patients who are HIV positive with those who are HIV negative.MethodsThis was a prospective cohort study involving burn injury patients admitted to Mulago Hospital between November 2005 and February 2006. Patients were stratified into HIV positive (exposed) group and HIV-negative (unexposed) group. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software version 11.5.ResultsOf the 130 patients included in the study, 17 (13.1%) patients tested HIV positive and this formed the study (exposed) group. The remaining 113 patients (86.9%) formed the control (unexposed) group. In the HIV positive group, females outnumbered males by a ratio of 1.4:1 and the mean age was 28.4 ± 21.5 years (range 3 months-34 years). 64.7% of HIV positive patients reported to have risk factors for HIV infection. Of these, multiple sexual partners [Odds Ratio 8.44, 95% C.I. (3.87-143.23), P = 0.011] and alcoholism [Odds Ratio 8.34, 95% C.I. (5.76-17.82), P = 0.002] were found to be independently and significantly associated with increased risk to HIV infection. The mean CD4 count for HIV positive and HIV negative patients were 394 ± 328 cells/μL and 912 ± 234 cells/μL respectively which is statistically significant (P = 0.001). There was no difference in the bacteria cultured from the wounds of HIV positive and negative patients (P = 0.322). Patients with clinical signs of sepsis had lower CD4+ counts compared to patients without sepsis (P < 0.001). ). Skin grafting was carried out in 35.3% of HIV negative patients and 29.4% of HIV positive patients with no significant difference in skin graft take and the degree of healed burn on discharge was the same (P = 0.324). There was no significant difference in hospital stay between HIV positive and negative patients (P = 0.674). The overall mortality rate was 11.5%. Using multivariate logistic regression analysis, mortality rate was found to be independently and significantly related to the age of the patient, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (p-value < 0.001).ConclusionHIV infection is prevalent among burn injury patients in our setting and thus presents an occupational hazard to health care workers who care for these patients. All burn health care workers in this region need to practice universal precautions in order to reduce the risk of exposure to HIV infection and post-exposure prophylaxis should be emphasized. The outcome of burn injury in HIV infected patients is dependent upon multiple variables such as age of the patient, inhalation injury and %TBSA and not the HIV status alone.

Prevalence of HIV infection among burn patients: is there a relationship with patients' outcomes?

“…Several studies have demonstrated the fact that HIV status does not impact the duration of inpatient stay . However, in disagreement, our results showed that HIV‐positive patients have a significantly longer hospital stay than HIV‐negative individuals.…”

“…Another report from Malawi revealed an HIV prevalence of 31% among burn patients admitted during a 1-year study period with inpatient HIV prevalence from 30% to 70% (7). Additionally, another study from Uganda showed that the overall seroprevalence of HIV infection was 13⋅1% and 6⋅5% in HIV burn patients and the general population, respectively (9). In another study, Sheyo (10) reported 16% of their burn patients with positive HIV infection, while the prevalence of HIV in burn patients was the same as in the general population.…”

Determination of lymphocytes surface markers in patients with thermal burns and the influence of burn size on mononuclear cell subsets

“…Insignificant changes in the level of CD16 (NK cells) population may induce apoptosis or activation induced cell death in mature lymphocytes. Therefore, it has to be taken into consideration that variable changes of CD19 + and CD16 + may contribute to the higher incidence of infection and sepsis in patients after burn injury, especially in cases with burns of >30% TBSA ( 26 , 32 , 35 ). Finally, the failure of peripheral blood lymphocytes to regulate the immune response is considered to be an important immunological and physiological consequence of major immunosuppression after thermal burn injury ( 1 , 4 , 36 - 40 ).…”

A Review of HIV and Surgery in Africa

“…This has placed stress on an already overstretched surgical work force. There has been an attempt to innovatively address this challenge by a number of strategies including task shifting, task sharing and increased training of surgical specialists [ 37 - 39 ].…”