Treatment of spondylodiscitis in human immunodeficiency virus-infected patients: a comparison of conservative and operative therapy.
METHODS
Multicenter retrospective case series.


OBJECTIVE
To determine relevant clinical presentation and outcome of human immunodeficiency virus (HIV)-positive patients with spondylodiscitis as a function of the treatment.


BACKGROUND
This is the first study comparing the clinical outcome of HIV-positive patients with spondylodiscitis as a function of the treatment.


METHODS
We performed a national multicenter retrospective case series comparing operatively versus conservatively treated HIV-positive patients with spondylodiscitis presenting between 1991 and 2007.


RESULTS
Twenty patients were included in the study. The average age of the patients at the time of admission was 43.0 years. The sex ratio m:w resulted in 2.3:1. On admission, 50% of the patients were in CDC stage C3. The CD4 T-cell count was determined as being 237.5/microL on average. At the occurrence of spondylodiscitis HIV had been known for a mean 8.5 years. In altogether 75% of the cases a pathogen was found. In 3 cases, mixed infections were present. Half of the patients received surgery. In none of these patients a wound infection or a delay of wound healing could be observed. One patient died during in-patient stay. Eleven of the 19 patients could be followed up a mean 13 months after discharge. In the follow-up period further 3 patients died on an average of 45 months after discharge.


CONCLUSIONS
The occurrence of spondylodiscitis in HIV-positive patients is associated with a low CD4 T-cell count. The probability of mixed infections rises with a CD4 T-cell count <100/microL. The occurrence of spondylodiscitis in HIV-positive patients is accompanied by high mortality. Operative therapy of spondylodiscitis in HIV-positive patients is not associated with an increased surgical complication rate. HIV infection or AIDS should not have an influence on decision-making regarding conservative or operative therapy of spondylodiscitis.
Sobottke
R
R
Department of Orthopaedic Surgery, University of Cologne, Cologne, Germany. rolf.sobottke@uk-koeln.de
Zarghooni
K
K
Krengel
M
M
Delank
S
S
Seifert
H
H
Fätkenheuer
G
G
Ernestus
I
I
Källicke
T
T
Frangen
T
T
Arasteh
K
K
Oette
M
M
Eysel
P
P
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000276:immunology; D000328:Adult; D018791:CD4 Lymphocyte Count; D015299:Discitis / Q000150:complications / Q000276:immunology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012189:Retrospective Studies; D055815:Young Adult