Wound Complications in HIV-Positive Male Patients with Fractures after Operation

Research Article

Austin J HIV/AIDS Res. 2014;1(1): 3.

Wound Complications in HIV-Positive Male Patients with Fractures after Operation

Xin Li, Qiang Zhang*, Changsong Zhao and Rugang Zhao

Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China

*Corresponding author: Qiang Zhang, Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China

Received: August 19, 2014; Accepted: September 11, 2014; Published: September 15, 2014


Objective: The aims of our study were to evaluate wound healing in human immunodeficiency virus (HIV)-positive male patients with fractures and make a comparison with HIV-negative patients.

Methods: Thirty HIV-positive male patients who underwent surgery for fractures were reviewed in this consecutive study. HIV-negative patients were chosen as controls. According to the CDC criteria, wounds were classified and reviewed, including surgical site infection (SSI) and other wound complication.

Results: Seven of the 30 HIV-positive patients suffered wound complications, including 1 SSI, whereas 1 HIV-negative patient had wound complications with 1 SSI. The incidence of wound complications was significantly increased in the HIV-positive patients compared to the HIV-negative patients; however, the difference of SSI was not significant.

Conclusion: HIV-positive male patients with fractures exhibited a higher incidence of wound complications compared to HIV-negative patients. However, all patients achieved satisfactory outcomes through correct management. Prompt interventions such as debridement, antibiotic and nutritional support, should be emphasized to minimize wound complications once any problem was recognized.

Keywords: Wound complication; Surgical site infection; HIV; AIDS; Fracture


By 2012, approximately 35.3million people globally were living with human immunodeficiency virus (HIV). About 2.3 million new HIV infections were noted in 2012 worldwide [1]. By September 2013, 43,400 people were living with HIV in China, 70,000 new infections were found meanwhile [2]. However, the number of AIDS mortality is declining annually due to highly active antiretroviral therapy (HAART), so that patients are leading longer lives [3]. The opportunity of surgery in HIV-positive patients increased at the same time. However, the misunderstanding and fear surrounding HIV made it difficult for surgeons to perform operations on HIV patients in China. HIV-positive patients without surgery may suffer from malunion, nonunion or limbs dysfunction.

HIV patients who suffered from immunosuppression carry an increased risk of wound complications. An increased incidence of perioperative complications, such as infection, poor healing, and mortality, was reported in HIV patients previously. The complications may cause increased morbidity, hospitalization expenses and stays, sepsis, and reoperation. Thus, wound healing is essential for achieving a satisfactory outcome. The aims of our study were to observe wound healing in HIV-positive male patients with fractures and make a comparison with HIV-negative patients.

Materials and Methods

HIV-positive male patients with fractures who were admitted to a single institute, Beijing Ditan Hospital, Capital Medical University, from June 2012 to June 2013 were included in this study. Data were gathered by reviewing electronic patient records and relevant images. An equal number of HIV-negative patients were selected as the controls, matched by disease, age and gender in the same period. Diseases that may impact wound healing, such as diabetes, tuberculosis, liver or kidney disease, chronic infection, malignant tumor, and connective tissue disease were excluded. Written informed consent was obtained from all patients before study enrollment. This study was performed and approved by the Institutional Ethics Committees at Beijing Ditan Hospital, Capital Medical University and conducted in accordance with the ethical guidelines of the Declaration of Helsinki.

HIV infection clinical stage was graded according to the clinical category and grading system drew by the U.S. Centers for Disease Control and Prevention (CDC) [4]. Surgical site infection (SSI) was diagnosed according to the CDC criteria [5]. Wound complications appeared such as SSI, swelling, exudation, dehiscence, hematoma, and fat liquefaction during the hospital stay.

All data were analyzed with SPSS software (version 17.0, SPSS, Chicago, USA). Fisher’s exact tests were used for count data. Significance was set at P<0.05.


In total, thirty HIV-positive male patients fulfilled the study criteria. The mean patient age at the time of admission was 38 years (range, 19-60 years). The patients were from 12 different provinces. The mean in-patient stay was 21.5 days (range, 8-42 days). Half of the patients were transferred to our institution after diagnosed HIV. Twenty-three patients had acquired HIV infection through sexual contact, whereas the others acquired the virus through blood transfusions and intravenous drug use. None had the history of trauma and surgery. No wound complications had been previously reported. Upon admission, 10 of the patients were previously administered HAART. Fifty-six HIV-negative patients were included. The difference in age between two groups was not significant (P>0.05).

All diagnoses were traumatic fractures. There were 11 cases of upper extremity fractures, 15 cases of lower extremity fractures, 3 cases of spinal fractures, and 1 cases of pelvic fracture. Twenty-six cases received plate and screw fixation, 1 cases of intramedullary nailing, and 3 cases of pedicle screw fixation. No patients suffered sepsis, opportunistic diseases, wasting syndrome, or HIV encephalopathy during hospitalization and follow-up.

Wound complications were observed in 7 of the HIV-positive patients, including 1 case of SSI. In 56 HIV-negative patients, 1 case of wound complications and 1 case of SSI were noted. No significant difference was noted in the incidence of SSI between the HIV-positive and HIV-negative patients (P>0.05). The difference in wound complications between the HIV-positive and HIV-negative patients was statistically significant (P<0.05) (Table 1). In the HIV-positive patients with wound complications, several types of complications were observed, including 4 cases of swelling, 2 cases of exudation, 1 cases of wound dehiscence, 1 case of SSI, 1 case of hematoma, 1 case of fat liquefaction, and 1 case of delayed healing. The ratio of CD4: A CD8 cell in the patient with SSI was 0.38.

Citation: Li X, Zhang Q, Zhao C and Zhao R. Wound Complications in HIV-Positive Male Patients with Fractures after Operation. Austin J HIV/AIDS Res. 2014;1(1): 3.