Implant orthopaedic surgery in HIV asymptomatic carriers: management and early outcome.

BACKGROUND: To the best of our knowledge, no reports currently exist on how to manage HIV infected patients in cases where they present with an absolute indication for implant surgery. The aim of this study was to compare the immediate and early outcome of implant orthopaedic surgery in HIV carriers with less than 500CD4/ml (group A) treated with a protective antiretroviral therapy and prolonged prophylactic antibiotic therapy in one group, and in the other group, HIV carriers with more than 500CD4/ml (group B) and non-HIV carriers (group C) treated conventionally. METHODS: During a 36-month-period, a protocol of screening and subsequent management of HIV carriage was proposed to patients admitted for internal clean trauma or orthopaedic implant surgery in our department. The HIV screening, its confirmation and the CD4 count were carried out by conventional methods. All group A patients were treated with cefuroxime for 10 days and a fixed combination of antiretroviral tritherapy before or just after surgery. Group B and C patients solely underwent surgery with a conventional 1.5g of cefuroxime. The wounds in the three groups were later examined at days 2, 7, 14, 45 and at 3 months. The rates of clinical wound infection were compared using the Fisher exact test; the difference was considered significant if p