Surgery in High-HIV Incidence Poor Countries

Cairns, James

doi:10.1177/004947550003000120

Cited by 7 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been reported that late sepsis occurs more commonly in patients whose immunity is compromised as a result of HIV disease [2,7,9,10,13]. Most such reports are based on follow-up of arthroplasties in haemophiliacs with HIV disease [7,10].…”

Section: Introductionmentioning

confidence: 99%

One-year follow-up of orthopaedic implants in HIV-positive patients

Harrison¹,

Lavy²,

Lewis

2004

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

We followed prospectively 38 orthopaedic implants in 36 HIV-positive patients. X-rays and clinical examination were used to assess union, and observation was made for early and late wound sepsis for 12 months from the time of surgery. Two patients died of causes unrelated to the implantation, two patients had implants removed for reasons other than infection and eight cases were lost to follow-up. Of the 26 cases that were reviewed at 1 year, no late sepsis was identified. All of the fractures, non-unions, osteotomies and arthrodeses united. The literature indicates that late sepsis following arthroplasty occurs more frequently in haemophiliacs who are HIV positive than their HIV-negative counterparts. It is still not certain whether or not such a risk also applies to HIVpositive patients who are not haemophiliacs and have undergone internal fixation of fractures or non-unions. This study increases the confidence that fixation in immune-compromised patients with intact skin is safe, at least for the time period that the implant is required. Further studies are required to know whether or not fixation implants should be removed.Résumé Nous avons suivi de façon prospective 38 implants orthopédiques chez 36 malades HIV-Positifs. La radiographie et l'examen clinique ont été utilisés pour étudier l'évolution et ont été recherchées les infections précoces et tardives survenant dans l'année suivant la chirurgie. Deux malades sont morts de causes sans rapport avec l'implantation, deux malades avaient des implants retirés pour des raisons autre qu'une infection, et huit cas ont été perdus de vue. Des 26 cas qui ont été examinés à une année, aucune infection tardive n'a été identifiée. Toutes les fractures, pseudarthroses, osteotomies et arthrodèses ont fusionnées. La littérature indique que les infections tardives après arthroplastie surviennent plus fréquemment chez les hémophiles séro-positifs que chez ceux qui sont séro-négatifs. Il n'est pas encore certain qu'un tel risque s'applique aussi à malades séropositifs qui ne sont pas des haemophiles. Cette étude augmente la confiance dans le fait que l'utilisation d'implants orthopédiques chez des patients immuno déprimés avec une peau intacte est sûre, au moins pour la période ou l'implant est nécessaire. Des études supplémentaires sont néces-saires pour savoir si les implants de fixation devraient être enlevés ou non.

show abstract

Section: Introductionmentioning

confidence: 99%

One-year follow-up of orthopaedic implants in HIV-positive patients

Harrison¹,

Lavy²,

Lewis

2004

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…A number of studies have highlighted the problems of increased infection in HIVpositive patients after surgery for trauma, [2][3][4] with the severity of the immunosuppression corresponding to that of septic complications after surgery. 5 Harrison, Lewis and Lavy 6 showed that the use of internal fixation in the management of closed fractures in HIVpositive patients is safe in appropriate circumstances, but they emphasised the increased risk of 42% of post-operative wound infection after internal fixation of heavily contaminated open fractures compared with 3.5% for closed fractures.…”

mentioning

confidence: 99%

Pin-track infection in HIV-positive and HIV-negative patients with open fractures treated by external fixation

Norrish¹,

Lewis

Harrison³

2007

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

Patients infected with HIV presenting with an open fracture of a long bone are difficult to manage. There is an unacceptably high rate of post-operative infection after internal fixation. There are no published data on the use of external fixation in such patients. We compared the rates of pin-track infection in HIV-positive and HIV-negative patients presenting with an open fracture. There were 47 patients with 50 external fixators, 13 of whom were HIV-positive (15 fixators). There were significantly more pin-track infections requiring pharmaceutical or surgical intervention (Checketts grade 2 or greater) in the HIV-positive group (t-test, p = 0.001). The overall rate of severe pin-track infection in the HIV-positive patients requiring removal of the external-fixator pins was 7%. This contrasts with other published data which have shown higher rates of wound infection if open fractures are treated by internal fixation. We recommend the use of external fixation for the treatment of open fractures in HIV-positive patients.

show abstract

“…Attempts to use measurements of immunosuppression (e.g., CD4 lymphocyte counts) to predict a poor surgical outcome have not found universal acceptance. Many surgeons have experienced catastrophic results (wound nonhealing and dehiscence, opportunistic infections, high mortality), especially with major surgery in AIDS patients not on antiretroviral therapy, a common scenario in many poor countries [2]. Surely a conservative approach is wise in some such circumstances, but what of the fit young man who needs nothing more than repair of a symptomatic hernia and is highly unlikely to manifest his HIV infection for some years?…”

Section: Who Should Be Tested?mentioning

confidence: 99%

The Surgeon and Human Immunodeficiency Virus

Mielke

Kalangu

2003

World j. surg.

View full text Add to dashboard Cite

The moral dilemmas faced by surgeons worldwide who treat patients infected with the human immunodeficiency virus (HIV) can be viewed against the background of experience in sub-Saharan countries, where the community prevalence is in excess of 25% (90% of hospital inpatients). When seeking consent for an HIV test before surgery, frank communication regarding the surgeons' perspective of risks to themselves and the patient is helpful. When consent for a test must be obtained from a substitute decision-maker, the surgeon should consider if the patient would want the decision-maker to know the result. Understanding the natural history of HIV in the surgical setting can help deal with the uncertainties encountered and should be a research priority for developing countries. International professional organizations are useful platforms for the exchange of ideas when surgeons encounter uncertainty by increasing access to journals and creating opportunities for discussion. Although supervisory bodies in some parts of the world prevent HIV-infected surgeons from putting patients at risk by offering surgery, the withdrawal of their services in developing countries can cause more harm than good. Surgeons in that position may be entitled to offer surgery but only with full disclosure of the risk of HIV infection to the patient. The decision-making process known as "accountability for reasonableness" allows surgeons to determine fairness, legitimacy, and acceptability when making resource allocation decisions involving patients with HIV.

show abstract

Surgery in High-HIV Incidence Poor Countries

Cited by 7 publications

References 0 publications

One-year follow-up of orthopaedic implants in HIV-positive patients

One-year follow-up of orthopaedic implants in HIV-positive patients

Pin-track infection in HIV-positive and HIV-negative patients with open fractures treated by external fixation

The Surgeon and Human Immunodeficiency Virus

Contact Info

Product

Resources

About