The seroprevalence of HIV in patients undergoing lower limb Total Joint Arthroplasty (TJA) in South Africa

Aim: The aim was to assess the seroprevalence of Human Immunodeficiency Virus (HIV) in non-haemophilic patients undergoing primary Total Joint Arthroplasty (TJA) at an academic hospital in South Africa.

Methods: A retrospective review of all Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) patients from January 2017 to December 2018 was conducted. All patients awaiting TJA were offered HIV screening and their demographic data were recorded. Consenting patients were tested or the refusal of testing was documented. The CD4+ T-cell count (CD4+) and viral load (VL) was measured for all HIV-positive patients and newly diagnosed patients were initiated on Highly Active Antiretroviral Treatment (HAART).

Results: We included 1007 patients in the study. The TJA population HIV seroprevalence was 10.7% (n = 108). The seroprevalence for THA was 14.9% (n = 78) and that for TKA was 6.2% (n = 30). There were 93 patients (9.2%) who refused screening. There were 12 (15.4%) and 3 patients (10%) that were newly diagnosed in the THA and TKA seropositive populations, respectively. The average CD4+ for THA and TKA was 569 cells/mm³ (105–1320) and 691 cells/mm³ (98–1406), respectively. The VL was undetectable in 75.9% (n = 82) of HIV-positive patients. Overall 12 HIV-positive patients (11.12%) had CD4+ <200 cells/mm³, 8 of these patients (66%) were newly diagnosed. The average age of the seropositive population was 58 ± 6.5 years and 66 ± 8.5 years for THA and TKA, respectively (p = 0.03). Femoral head osteonecrosis was the underlying pathology for 65.38% (n = 51) of seropositive patients for THA.

Conclusion: The seroprevalence of HIV in patients undergoing THA in our South African institution is greater than the seroprevalence in the general population. The seroprevalence of HIV in THA is significantly greater than that in TKA. This may reflect the association between HIV, HAART and hip joint degeneration. Our findings draw attention to the significant burden HIV has on TJA.