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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 8, 988-994.
doi: 10.1302/0301-620X.90B8.20861  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Fracture healing in HIV-positive populations

J. Richardson, BSc, MA, Research Assistant1; A. M. Hill, MB, PhD, DIC, Honorary Research Assistant1; C. J. C. Johnston, MB, BS, BSc, House Surgeon1; A. McGregor, PhD, MSc, MCSP, Reader in BioDynamics Surgery, Oncology, Reproductive Biology and Anaesthesia1; A. R. Norrish, Master of Laws, PhD, FRCS(Orth), Consultant Orthopaedic Surgeon2; D. Eastwood, FRCS, Consultant Orthopaedic Surgeon3; and C. B. D. Lavy, OBE, MCh, FRCS, Professor of Orthopaedics4

1 Faculty of Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
2 Tropical Surgery Research and Training Unit, Beit CURE Hospital, P. O. Box 36391, Lusaka, Zambia.
3 Department of Orthopaedics, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK.
4 Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford 0X3 7LD, UK.

Correspondence should be sent to Dr A. McGregor; e-mail: a.mcgregor{at}imperial.ac.uk

Highly active anti-retroviral therapy has transformed HIV into a chronic disease with a long-term asymptomatic phase. As a result, emphasis is shifting to other effects of the virus, aside from immunosuppression and mortality. We have reviewed the current evidence for an association between HIV infection and poor fracture healing.

The increased prevalence of osteoporosis and fragility fractures in HIV patients is well recognised. The suggestion that this may be purely as a result of highly active anti-retroviral therapy has been largely rejected. Apart from directly impeding cellular function in bone remodelling, HIV infection is known to cause derangement in the levels of those cytokines involved in fracture healing (particularly tumour necrosis factor-{alpha}) and appears to impair the blood supply of bone.

Many other factors complicate this issue, including a reduced body mass index, suboptimal nutrition, the effects of anti-retroviral drugs and the avoidance of operative intervention because of high rates of wound infection. However, there are sound molecular and biochemical hypotheses for a direct relationship between HIV infection and impaired fracture healing, and the rewards for further knowledge in this area are extensive in terms of optimised fracture management, reduced patient morbidity and educated resource allocation. Further investigation in this area is overdue.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General