The incidence of the human immunodeficiency virus in injured patients in Lusaka
Kehoe, N.J.; Jellis, J.E.
Injury 25(6): 375-378
1994
ISSN/ISBN: 0020-1383 PMID: 8045641 DOI: 10.1016/0020-1383(94)90129-5Document Number: 287482
The specific effect of HIV on the presentation and progression of skeletal disease has yet to be fully determined. This paper reports findings from a long-term, multidisciplinary study being conducted at the University of Zambia to assess the influence of HIV on the presentation, treatment, and outcome of surgical pathology. Approximately 25% of Zambia's urban adult population is HIV-seropositive. The study assesses the magnitude of the HIV problem in injured patients and the discrepancy between clinical and hematological evidence of HIV disease. It specifically examines the HIV status of 100 patients presenting through the Accident Department with long bone fractures. Researchers compared assessment using the World Health Organization (WHO) clinical staging system for HIV disease to the patient's response to the potential immunological challenge and HIV serological status. 107 consecutive patients over the period April-August 1992 aged 16-55 years of median age 19 years with long bone fractures requiring inpatient treatment were studied prospectively. Children were excluded from study to permit specific assessment of the age group most exposed to sexually acquired HIV infection. 32% of adults aged 16-55 years and 50% of those aged 21-40 years were HIV-seropositive. The majority of patients were male, but both sexes had similar patterns of serological status. All patients were in WHO stage 0, 1, or 2, but assessment with the WHO clinical criteria alone led to an high level of diagnostic inaccuracy. Clinical assessment of 18 patients suggested freedom from HIV influence, but their serum was seropositive on testing with ELISA. The absolute lymphocyte count was below 2000 cells per cubic millimeter in patients found to be seropositive and with disease in clinical stage 1 or 2. The authors conclude that HIV infection is becoming more common and may be coincidental to the presenting pathology. Physicians and other concerned health personnel need to be aware of this phenomenon. Alterations in the indications for specific therapeutic regimens may need to be made as the results of further studies on the effects of HIV become available.