J Neurol Surg A Cent Eur Neurosurg 2021; 82(05): 468-474
DOI: 10.1055/s-0041-1724111
Review Article

HIV and Surgery for Degenerative Spine Disease: A Systematic Review

1   University of Caxias do Sul, Caxias do Sul, Brazil
,
1   University of Caxias do Sul, Caxias do Sul, Brazil
,
Asdrubal Falavigna
2   Health Sciences Postgraduate Program, University of Caxias do Sul, Caxias do Sul, RS, Brazil
› Author Affiliations

Abstract

Background and Study Aims The objective of this review is to evaluate the incidence of operative treatment, outcomes, and complications of surgery for degenerative spine disease (DSD) on human immunodeficiency virus (HIV) positive patients. Combined antiretroviral treatment led HIV patients to live long enough to develop many chronic conditions common in the uninfected population. Surgery for DSD is one of the most commonly performed neurosurgical procedures. However, the incidence of spine surgery for DSD in HIV-positive patients seems to be lower than that in uninfected individuals, although this has not been clearly determined.

Methods A systematic search of the Medline, Web of Science, Embase, and SciElo databases was conducted. Only primary studies addressing DSD surgery on HIV-positive patients were included. Evaluated variables were rates of surgical treatment, surgical outcomes and complications, year of publication, country where study was conducted, type of study, and level of evidence.

Results Six articles were included in the review from 1,108 records. Significantly lower rates of DSD surgery were identified in HIV-infected patients (0.86 per 1,000 patient-years) when compared with uninfected patients (1.41 per 1,000 patient-years). There was a significant increase in spinal surgery in HIV-positive patients over time, with a 0.094 incidence per 100,000 in the year 2000 and 0.303 in 2009. HIV-positive patients had very similar outcomes when compared with controls, with 66.6% presenting pain relief at a 3-month follow-up. Higher incidences of hospital mortality (1.6 vs. 0.3%; p < 0.001) and complications (12.2 vs. 9.5%, p < 0.001) were observed in HIV carriers.

Conclusions HIV-positive individuals appear to undergo less surgery for DSD than HIV-negative individuals. Improvement rates appear to be similar in both groups, even though some complications appear to be more prevalent in HIV carriers. Larger studies are needed for decisive evidence on the subject.



Publication History

Received: 24 March 2020

Accepted: 22 September 2020

Article published online:
12 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 World Health Organization. Global Health Observatory (GHO) data HIV/AIDS. 2019 . Available at: https://www.who.int/gho/hiv/en/
  • 2 Fettig J, Swaminathan M, Murrill CS, Kaplan JE. Global epidemiology of HIV. Infect Dis Clin North Am 2014; 28 (03) 323-337
  • 3 Deeks SG, Overbaugh J, Phillips A, Buchbinder S. HIV infection. Nat Rev Dis Primers 2015; 1: 15035
  • 4 Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet 2013; 382 (9903): 1525-1533
  • 5 Ravindra VM, Senglaub SS, Rattani A. et al. Degenerative lumbar spine disease: estimating global incidence and worldwide volume. Global Spine J 2018; 8 (08) 784-794
  • 6 Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ 2007; 334 (7607): 1313-1317
  • 7 Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine 2008; 33 (22) 2464-2472
  • 8 Gugliotta M, da Costa BR, Dabis E. et al. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open 2016; 6 (12) e012938
  • 9 Karppinen J, Shen FH, Luk KD, Andersson GB, Cheung KM, Samartzis D. Management of degenerative disk disease and chronic low back pain. Orthop Clin North Am 2011; 42 (04) 513-528 , viii
  • 10 Marquez-Lara A, Nandyala SV, Fineberg SJ, Singh K. Current trends in demographics, practice, and in-hospital outcomes in cervical spine surgery: a national database analysis between 2002 and 2011. Spine 2014; 39 (06) 476-481
  • 11 Kobayashi K, Ando K, Nishida Y, Ishiguro N, Imagama S. Epidemiological trends in spine surgery over 10 years in a multicenter database. Eur Spine J 2018; 27 (08) 1698-1703
  • 12 Pumberger M, Chiu YL, Ma Y, Girardi FP, Mazumdar M, Memtsoudis SG. National in-hospital morbidity and mortality trends after lumbar fusion surgery between 1998 and 2008. J Bone Joint Surg Br 2012; 94 (03) 359-364
  • 13 Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine 2012; 37 (01) 67-76
  • 14 Lovy AJ, Guzman JZ, Skovrlj B, Cho SK, Hecht AC, Qureshi SA. Prevalence, comorbidities, and risk of perioperative complications in human immunodeficiency virus-positive patients undergoing cervical spine surgery. Spine 2015; 40 (21) E1128-E1134
  • 15 Yoshihara H, Yoneoka D. National trends and in-hospital outcomes in HIV-positive patients undergoing spinal fusion. Spine 2014; 39 (20) 1694-1698
  • 16 Dimitroulis D, Karaolanis G, Katafigiotis I. et al. Influence of HIV virus in the hospital stay and the occurrence of postoperative complications classified according to the Clavien-Dindo classification and in comparison with the Charlson Comorbidity Index in patients subjected to urologic and general surgery operations. Our preliminary results. Arch Ital Urol Androl 2017; 89 (02) 125-129
  • 17 Moher D, Shamseer L, Clarke M. et al; PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1
  • 18 Oxford Centre for Evidence-based Medicine. Oxford Centre for Evidence-Based Medicine: Levels of Evidence. 2009 . Accessed January 21, 2019 at: https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/
  • 19 King Jr JT, Gordon AJ, Perkal MF. et al. Disparities in rates of spine surgery for degenerative spine disease between HIV-infected and uninfected veterans. Spine 2012; 37 (07) 612-622
  • 20 Young WF, Axelrod P, Jallo J. Elective spinal surgery in asymptomatic HIV-seropositive persons: perioperative complications and outcomes. Spine 2005; 30 (02) 256-259
  • 21 Donnally III CJ, Kalakoti P, Buskard ANL. et al. Inpatient outcomes after elective lumbar spinal fusion for patients with human immunodeficiency virus in the absence of acquired immunodeficiency syndrome. World Neurosurg 2018; 116: e913-e920
  • 22 Eyenga VC, Ngowe NN, Minkande JZ, Ngah JE. Kinetics of regression of sciatica and pain in the low back after lumbar macrodiscectomy in human immunodeficiency virus carriers. Spine 2008; 33 (13) E411-E413
  • 23 Vella S, Schwartländer B, Sow SP, Eholie SP, Murphy RL. The history of antiretroviral therapy and of its implementation in resource-limited areas of the world. AIDS 2012; 26 (10) 1231-1241
  • 24 Skowron G, Bozzette SA, Lim L. et al. Alternating and intermittent regimens of zidovudine and dideoxycytidine in patients with AIDS or AIDS-related complex. Ann Intern Med 1993; 118 (05) 321-330
  • 25 Injeyan HS, Connell G, Foster K, Kopansky-Giles D, Sovak G, Tibbles T. The prevalence and characteristics of HIV/AIDS patients presenting at a chiropractic outpatient clinic in Toronto, Ontario. A retrospective, observational study. J Can Chiropr Assoc 2018; 62 (02) 77-84
  • 26 Wandeler G, Johnson LF, Egger M. Trends in life expectancy of HIV-positive adults on antiretroviral therapy across the globe: comparisons with general population. Curr Opin HIV AIDS 2016; 11 (05) 492-500
  • 27 Sabin CA. Do people with HIV infection have a normal life expectancy in the era of combination antiretroviral therapy?. BMC Med 2013; 11: 251
  • 28 Avila D, Althoff KN, Mugglin C. et al; IeDEA and ART Cohort Collaborations. Immunodeficiency at the start of combination antiretroviral therapy in low-, middle-, and high-income countries. J Acquir Immune Defic Syndr 2014; 65 (01) e8-e16
  • 29 Mello A, Gravel T. HIV pain management challenges and alternative therapies. Nursing 2017; 47 (04) 67-70
  • 30 Scott W, Arkuter C, Kioskli K. et al. Psychosocial factors associated with persistent pain in people with HIV: a systematic review with meta-analysis. Pain 2018; 159 (12) 2461-2476
  • 31 Nair SN, Mary TR, Prarthana S, Harrison P. Prevalence of pain in patients with HIV/AIDS: a cross-sectional survey in a south Indian state. Indian J Palliat Care 2009; 15 (01) 67-70
  • 32 Parker R, Stein DJ, Jelsma J. Pain in people living with HIV/AIDS: a systematic review. J Int AIDS Soc 2014; 17: 18719
  • 33 Kole AK, Roy R, Kole DC. Musculoskeletal and rheumatological disorders in HIV infection: experience in a tertiary referral center. Indian J Sex Transm Dis AIDS 2013; 34 (02) 107-112
  • 34 Miaskowski C, Penko JM, Guzman D, Mattson JE, Bangsberg DR, Kushel MB. Occurrence and characteristics of chronic pain in a community-based cohort of indigent adults living with HIV infection. J Pain 2011; 12 (09) 1004-1016
  • 35 CDC. Update: Trends in AIDS Incidence–United States, 1996. 1997 . Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/00049322.htm
  • 36 CDC. Estimated rates of adults and adolescents living with a diagnosis of HIV infection, by area of residence, year-end 2008—40 states and 5 U.S. dependent areas with confidential name-based HIV infection reporting N = 679,590], 2009. Available at: https://www.cdc.gov/hiv/pdf/statistics_2009_HIV_Surveillance_Report_vol_21.pdf
  • 37 World Health Organization. Cameroon. 2005 . Available at: https://www.who.int/hiv/HIVCP_CMR.pdf
  • 38 Centers for Disease Control and Prevention. Occupational HIV Transmission and Prevention among Health Care Workers. April 17, 2015. Accessed April, 21, 2019 at: https://www.cdc.gov/hiv/workplace/healthcareworkers.html
  • 39 Wyżgowski P, Rosiek A, Grzela T, Leksowski K. Occupational HIV risk for health care workers: risk factor and the risk of infection in the course of professional activities. Ther Clin Risk Manag 2016; 12: 989-994
  • 40 Migaud P, Silverman M, Thistle P. HIV status and mortality of surgical inpatients in rural Zimbabwe: a retrospective chart review. South Afr J HIV Med 2019; 20 (01) 812
  • 41 Savioz D, Chilcott M, Ludwig C. et al. Preoperative counts of CD4 T-lymphocytes and early postoperative infective complications in HIV-positive patients. Eur J Surg 1998; 164 (07) 483-487
  • 42 Kigera JW, Straetemans M, Vuhaka SK, Nagel IM, Naddumba EK, Boer K. Is there an increased risk of post-operative surgical site infection after orthopaedic surgery in HIV patients? A systematic review and meta-analysis. PLoS One 2012; 7 (08) e42254