Treatment of spondylodiscitis in human immunodeficiency virus-infected patients: a comparison of conservative and operative therapy

Spine (Phila Pa 1976). 2009 Jun 1;34(13):E452-8. doi: 10.1097/BRS.0b013e3181a0aa5b.

Abstract

Study design: Multicenter retrospective case series.

Objective: To determine relevant clinical presentation and outcome of human immunodeficiency virus (HIV)-positive patients with spondylodiscitis as a function of the treatment.

Summary of background data: This is the first study comparing the clinical outcome of HIV-positive patients with spondylodiscitis as a function of the treatment.

Methods: We performed a national multicenter retrospective case series comparing operatively versus conservatively treated HIV-positive patients with spondylodiscitis presenting between 1991 and 2007.

Results: Twenty patients were included in the study. The average age of the patients at the time of admission was 43.0 years. The sex ratio m:w resulted in 2.3:1. On admission, 50% of the patients were in CDC stage C3. The CD4 T-cell count was determined as being 237.5/microL on average. At the occurrence of spondylodiscitis HIV had been known for a mean 8.5 years. In altogether 75% of the cases a pathogen was found. In 3 cases, mixed infections were present. Half of the patients received surgery. In none of these patients a wound infection or a delay of wound healing could be observed. One patient died during in-patient stay. Eleven of the 19 patients could be followed up a mean 13 months after discharge. In the follow-up period further 3 patients died on an average of 45 months after discharge.

Conclusion: The occurrence of spondylodiscitis in HIV-positive patients is associated with a low CD4 T-cell count. The probability of mixed infections rises with a CD4 T-cell count <100/microL. The occurrence of spondylodiscitis in HIV-positive patients is accompanied by high mortality. Operative therapy of spondylodiscitis in HIV-positive patients is not associated with an increased surgical complication rate. HIV infection or AIDS should not have an influence on decision-making regarding conservative or operative therapy of spondylodiscitis.

Publication types

  • Multicenter Study

MeSH terms

  • AIDS-Related Opportunistic Infections / complications*
  • AIDS-Related Opportunistic Infections / immunology
  • Adult
  • CD4 Lymphocyte Count
  • Discitis / complications
  • Discitis / immunology
  • Discitis / therapy*
  • Female
  • Follow-Up Studies
  • HIV Infections / complications*
  • HIV Infections / immunology
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Patient Compliance / statistics & numerical data
  • Patient Discharge / statistics & numerical data
  • Postoperative Complications
  • Retrospective Studies
  • Young Adult