HIV/AIDS in trauma and orthopedic surgery
Immune deficiency associated with pneumocystis carinii pneumonia and Kaposi’s sarcoma was first recognised in the United States in 1981. The causative virus, now known as the human immunodeficiency virus (HIV), was identified in 1983 by Barre-Sinoussi, Montagnier and colleagues at the Institut Pasteur, Paris.1,2 The resulting disease has been known as acquired immune deficiency syndrome (AIDS).
In 1983 Bayley3 described aggressive cases of Kaposi’s sarcoma in Zambia. In the same hospital in Lusaka, Jellis4 highlighted the musculoskeletal manifestations of HIV-AIDS.
The author’s interest in the relation of HIV to the practice of orthopaedic and trauma surgery began during post-graduate training in Bulawayo, Zimbabwe in 1994, and has continued in Blantyre, Malawi since 1999.
HIV is a retrovirus which encodes its genome in RNA and transcribes genome copies in DNA using the enzyme reverse transcriptase. This occurs within host cells such as the human CD4 (T helper) lymphocyte. HIV is marked by a fall in the CD4 cell count with an associated decrease in immunity, particularly in humoral immunity.
Antiretroviral therapies such as nucleoside analogues and protease inhibitors reduce the viral load in the host serum and restore the numbers of host CD4 cells. The infected individual is not cured but their immunity is at least partially restored.