Courtesy: Prof Alfonso Manzotti, MD, Chief of Orthopaedics, Luigi Sacco Hospital, Milan, Italy

 

HIV in Orthopaedics

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Overview

• Human Immunodeficiency Virus (HIV) remains a major global health concern
• Advances in treatment have:
  • Improved survival
  • Transformed HIV into a chronic manageable disease

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Orthopaedic Relevance

• Focus has shifted to:
  • Chronic complications
  • Bone health
  • Infection risk

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Epidemiology

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• Affects millions worldwide
• Prevalence varies by region
• Increased screening — earlier diagnosis

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Virology and Transmission

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Virus Characteristics

• HIV is a retrovirus
• Targets:
  • CD4+ T lymphocytes

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Modes of Transmission

• Unprotected sexual contact
• Blood exposure
• Needle sharing
• Mother-to-child transmission

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Key Determinant

• Viral load influences transmission risk

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Clinical Stages of HIV

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1. Asymptomatic Phase

• No symptoms
• May last several years

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2. Symptomatic Phase

• Mild infections
• General constitutional symptoms

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3. Advanced Disease (AIDS)

• Severe immunosuppression
• Opportunistic infections
• Malignancies

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Classification

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Based On

• Clinical symptoms
• CD4 cell count

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Purpose

• Guides:
  • Treatment decisions
  • Prognosis

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Diagnosis

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Testing Methods

• Antigen–antibody combination tests
• Rapid diagnostic tests
• Confirmatory laboratory tests

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Important Consideration

• Window period may affect results

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Antiretroviral Therapy (ART)

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Cornerstone of Treatment

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Goals

• Suppress viral load
• Restore immune function
• Prevent transmission

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Key Principle

• Early initiation
• Lifelong adherence required

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Monitoring and Follow-up

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Routine Monitoring

• Viral load
• CD4 count

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Purpose

• Assess treatment response
• Detect complications early

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Opportunistic Infections

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Cause

• Immune suppression

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Common Infections

• Tuberculosis
• Fungal infections
• Viral infections

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Management

• Prevention
• Early diagnosis
• Prompt treatment

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Chronic Complications

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Systemic Effects

• Cardiovascular disease
• Metabolic abnormalities

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Orthopaedic Impact

• Bone disorders:
  • Osteopenia
  • Osteoporosis

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Mechanism

• Chronic inflammation
• Effects of ART

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Bone Health in HIV

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Increased Risk

• Reduced bone mineral density

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Contributing Factors

• Chronic inflammation
• Antiretroviral drugs
• Nutritional deficiencies

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Management

• Calcium supplementation
• Vitamin D supplementation
• Lifestyle modification
• Pharmacological therapy when needed

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Lifestyle and Support

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Essential Measures

• Balanced nutrition
• Regular physical activity
• Mental health support

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Importance

• Improves adherence
• Enhances long-term outcomes

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Prevention Strategies

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• Safe sexual practices
• Regular screening in high-risk groups
• Prophylaxis when indicated
• Public awareness and education

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Post-Exposure Prophylaxis (PEP)

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Indication

• After potential HIV exposure

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Key Points

• Start as early as possible
• Requires:
  • Medical supervision
  • Follow-up testing

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Special Considerations

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• Co-infections (e.g., hepatitis)
• Drug interactions
• Need for individualized treatment

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Conclusion

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• HIV is now a chronic manageable condition
• Early diagnosis + consistent ART = better outcomes
• Long-term care focuses on:
  • Monitoring
  • Complication prevention
  • Holistic patient management