Aim. To conduct a systematic review and meta-analysis comparing the development of early and late fracture-related infections (FRI) following closed and open fractures in HIV-positive and HIV-negative patients. Method. A systematic literature search was conducted using MEDLINE through the OVID interface, ProQuest, Web of Science, The Cochrane Library and Scopus. Only studies involving HIV-positive who underwent operative fixation (internal or external) of open or closed fractures, with a HIV-negative control group, were considered eligible. Following eligibility assessment, studies were included with the main outcome of interest being the development of either early or late fracture-related infection at the site of surgery in patients with open and closed fractures. Results. Eleven studies were included (n = 2634). The studies’ follow-up periods were between one and 39 months with an average of 11 months. Three studies were conducted before the introduction of ARV (anti-retroviral) therapy (1994) and two did not involve any patients on ARV's. Across the entire group, for both open and closed fractures, the risk of a fracture-related infection was greater in HIV-positive patients (Odds ratio (OR) = 1.61; 95% CI = 0.93–2.79, p = 0.04). When looking at closed fractures treated operatively, an OR = 4.59 was found in HIV-positive patients in terms of the risk of fracture-related infection (95% CI = 0.30–68.99, p < 0.001). Open fractures showed similar results with an OR of 3.48 in HIV-positive patients (95% CI = 0.55 – 21.99, p < 0.001). Studies performed prior to the widespread introduction of anti-retroviral therapy and/or did not have any patients on antiretroviral therapy showed a greater infection risk in patients living with HIV infection with OR 3.53 (95% CI = 1.85 – 6.74, p = 0.36). However, studies performed in the era after the introduction of antiretroviral therapy showed no increase of infection risk for HIV-positive patients with an OR = 0.91 (95% CI = 0.58 – 1.43, p = 0.76). Conclusions. The assumption that HIV infection increases the risk for fracture-related infection remains unsubstantiated. The introduction of anti-retroviral therapy may have confounded the issue and we noted an apparent decrease in the risk in later studies. More data is required from well-designed larger studies to inform future analysis

Low-energy fractures complications are a major public health issue that make osteoporosis even worse. In sub-Saharan Africa, the prevalence of osteoporosis varies from 18.2% to 65.8%. There was no change in bone mineral density between HIV-infected and non-HIV-infected women in Sub-Saharan Africa, where HIV is widespread. Other investigations that demonstrated that HIV-infected people had poor BMD both before and after starting anti-retroviral treatment did not consistently show a low BMD finding. Inflammation-mediated bone remodelling has been associated with low BMD in HIV-infected patients. Antiretroviral Therapy has been demonstrated to exacerbate bone loss in addition to the pre-existing intrinsic risk of developing osteoporosis. Question: Is there loss of bone in HIV-infected patients before initiating ART?. The patients who were HIV-positive and enrolled in the ADVANCE research were retrospectively reviewed on a desk. All of the 1053 individuals in the ADVANCE research had a DXA scan performed to evaluate BMD as part of the initial screening and recruitment approach. The ADVANCE research enrolled HIV-positive people and randomly assigned them to three ART arms. A total of 400 patients were reviewed. Of these 400 records reviewed, 62.3% were female. 80% of the participants were younger than 40 years old, and 3% were older than 50 years. 82% were virally suppressed with less than 50 viral copies. The prevalence of osteopenia was 25.5% and osteoporosis was 2.8%, observed in predominantly African female participants aged between 30 and 39 years. The findings of this study confirm that there is pre-existing bone loss among HIV-infected ART naïve individuals. Approximately 28.3% in our study had clinically confirmed evidence of bone loss and of these, 2.8% of the entire cohort had osteoporosis. Bone loss was most prevalent in black females who are virologically suppressed