title: Human Immunodeficiency Virus and Total Joint Arthroplasty: The Risk for Infection Is Reduced.
abstract: Highly active antiretroviral therapy (HAART) has changed the face of human immunodeficiency virus (HIV) and allowed patients to live for many decades. HIV and HAART are known risk factors for osteonecrosis of bone, osteopenia, and osteoporosis. Therefore, the demand for total joint arthroplasty (TJA) in HIV-infected patients is on the rise. We attempted to determine whether modern treatments for HIV have impacted the rate of periprosthetic joint infection (PJI).
  
  
  
  Conducting a systematic review, 25 studies with a total of 722 TJAs were identified. We extracted data on rates of PJI after primary TJA in HIV-infected patients with and without hemophilia and data on administration of HAART at the time of arthroplasty.
  
  
  
  Three hundred eighty-one TJAs were performed in 293 patients with HIV infection without hemophilia. The follow-up ranged between 1.5 months and 11 years. Nine patients developed PJI. In patients with both HIV and hemophilia, 341 primary TJAs were performed. Forty-five received treatment for PJI. Follow-up ranged between 1 year and 26 years. Rates of PJI were 2.28% and 10.98% for HIV-only patients and patients with HIV and hemophilia, respectively. This difference was statistically significant (P < .0001) with a 5.28 odds ratio for hemophilia. HAART was associated with fewer infections overall (odds ratio, 0.12).
  
  
  
  The rates of PJI after TJA in HIV-only patients are lower than those in patients with both HIV and hemophilia. Treatment of patients with HAART and optimization of underlying comorbidities appears to lower the rate of PJI in this patient population.
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Enayatollahi
authors.affiliation: Department of Orthopedics, Midlands Regional Hospital, University of Limerick, Tullamore, Ireland.
authors.forename: Dermot
authors.initials: D
authors.lastname: Murphy
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Maltenfort
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D001170:Arthritis, Infectious / Q000209:etiology; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D016017:Odds Ratio; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors
keywords: hemophilia; highly active antiretroviral therapy; human immunodeficiency virus; periprosthetic joint infection; total joint arthroplasty