



HIV and Burns (More About ... Burns) (Clinical Report)
CME: Your SA Journal of CPD 2008, Sept, 26, 9
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Publisher Description
Antiretroviral treatment (ART) has increased life expectancy and the quality of life of many patients infected with the human immunodeficiency virus (HIV). As patients live longer many are admitted with conditions not related to HIV infection, for example trauma and burns. Practitioners are challenged by decisions regarding the management of immunocompetent burns patients. There are no randomised trials and no consensus guidelines for the management of HIV and burns. In 1998 Rose et al. (1) reviewed the literature dealing with complications of surgery in HIV-infected patients. They found that the literature is largely descriptive, retrospective and inconsistent. The writers concluded that the ultimate outcome of surgery in HIV-infected patients is probably dependent upon many independent variables and not just on the underlying viral infection or disease stage. Edge et al., (2) in a South African study, found that HIV status did not alter the outcome of treatment after moderate to severe burns as long as the stigmata of AIDS are not present. In a study by James et al. (3) in Malawi, it was found that mortality was higher among HIV-positive individuals. Length of hospital stay, the need for blood transfusions, antibiotics and intravenous fluid administration were not affected. There was also no difference in skin graft take. In contrast Mzezewa et al. (4) found impaired graft survival after split skin grafting of burn wounds and prolonged hospital stay in patients with HIV. In another study Sjoberg et al. (5) found no difference in the mortality rate or the length of hospitalisation between patient groups with or without HIV. The number of CD4+ T-lymphocytes was lower in burn patients compared with healthy volunteers. HIV-infected burn patients had lower CD4+ T-lymphocyte counts than non-HIV-infected patients. Patients with clinical signs of sepsis had lower CD4+ counts compared with patients without sepsis. The authors concluded that burn injury, HIV infection and sepsis independently result in immunosuppression. Finally, in a recent large study on 31 338 adult burn patients, Thombs et al. (6) found that patients with acute burn injury with pre-burn medical conditions are at greater risk for mortality and require longer hospital stays prior to discharge. In particular patients with HIV/AIDS, metastatic cancer, renal disease, and liver disease are at very high risk for mortality compared with patients without those diseases who have similar burn injuries. It can be concluded that HIV status is a serious complication in burns, but it does not preclude treatment.