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Hip prosthesis and HIV
Sep 6, 2012

I had a hip replacement in 1991. Diagnosed with HIV in 1994. Had septicemia in Jan/Feb and the hip was removed and a spacer was placed in. CD 4 count in Jan was 47 and it inceased to 225 last week. Viral load undetectable. My orthopaedic surgeon feels we should wait till my CD4 is in the 400s before we replace the spacer with a more permanent prosthesis. I do understand that the higher the count the less risk of infection reduces. I am not sure if I can live with the spacer till that happens. It may be only in next year. Your advise is apptrciated.

Response from Dr. Wohl

WHere this 400 CD4 cell count number came from I don't know. Our orthopedic surgeons have the same line in the sand for elective surgery. There was a study a few years back that showed that surgical infections and complications were slightly more common among folks with HIV but this was driven by those with much lower CD4 cell counts.

The body's ability to fight bacteria is not the major problem with HIV. Therefore, there should not be a much higher risk of infections. I would ask your HIV doc to get involved and lobby for a lower threshold.

DW



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