Infection after total joint arthroplasty in patients with human immunodeficiency virus or intravenous drug use

Patients with intravenous drug use (IVDU) and patients with human immunodeficiency virus (HIV) with painful joint arthrosis present a difficult treatment decision. The purpose of this study was to determine the rate of deep periprosthetic infection in patients with HIV or IVDU after total joint arthroplasty (TJA). Twenty-nine patients with HIV or a history of IVDU or both underwent TJA. Of 28 HIV-positive patients undergoing TJA, 4 (14%) developed infections. Two of 8 joints (25%) in the IVDU group developed an infection. Two of 5 joints (40%) with both IVDU and HIV developed a deep infection. Patients with HIV or a history of IVDU are more likely to develop a deep infection compared with other patients undergoing TJA. The decision to proceed with TJA in HIV-positive and IVDU patients should be made only after weighing the ratio of risks and benefits.