Co-Infection with Hepatitis C and HIV in Total Hip Arthroplasty: An Incremental Effect of Disease Burden

Background: Individuals co-infected with both Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) represent a unique and growing population of patients undergoing orthopaedic surgical procedures. Data regarding complications for HCV monoinfection or HIV monoinfection is robust, but there exists a paucity of data regarding co-infected individuals.

Methods: New York Statewide Planning and Research Cooperative System (SPARCS) database was used to identify patients undergoing total hip arthroplasty (THA) between 2010 and 2014. Patients were stratified into four groups based upon HCV/HIV status: healthy controls without disease, HCV monoinfection, HIV monoinfection, and co-infection. Differences regarding hospital LOS (days), total charges in United States Dollars ($USD), discharge disposition, in-hospital complications, in-hospital mortality, and 90-day hospital readmission were calculated.

Results: 80,722 patients underwent THA between 2010 and 2014. 98.55% of patients had neither HCV nor HIV, 0.66% had HCV monoinfection, 0.66% HIV monoinfection and 0.13% were co-infected with both HCV and HIV. Co-infected patients were more likely to be younger, male, insured by Medicaid, have a history of avascular necrosis, and be homeless. Additionally, co-infected patients had the highest rates of alcohol abuse, drug abuse, tobacco use, along with high rates of psychiatric disorders, including depression. HCV and HIV co-infection was an independent risk factor for increased LOS (OR 1.97, 1.29 – 3.01, p<0.001) and total hospital charges in the 90^th percentile (OR 1.83, 1.14 – 3.02, p<0.001), having 2 or more in-hospital complications (OR 1.64, 1.01 – 2.67, p<0.001), and 90-day readmission rates (OR 2.97, 1.86 – 4.77, p<0.001).

Conclusion: As the prevalence of HCV and HIV co-infectivity continues to increase, orthopaedic surgeons will encounter a greater number of these patients. Awareness of the demographic and socioeconomic factors leading to increased complications after THA will allow physicians to consider interventions to improve patient health status in order to optimize outcomes and reduce costs.