World AIDS Day is observed annually on December 1st to raise awareness about the AIDS pandemic caused by the spread of HIV infection and to mourn those who have died from the disease. First established in 1988, it was the first-ever global health day. The day serves as a reminder to unite in the fight against HIV, show support for people living with HIV, and remember those who have lost their lives to AIDS-related illnesses. HIV in Orthopedic Surgery: Considerations and Implications Human Immunodeficiency Virus (HIV) is a global health concern that affects millions of individuals worldwide. With advancements in antiretroviral therapy (ART), people living with HIV can now expect a near-normal life expectancy. However, HIV-positive patients still face significant health challenges, including those requiring orthopedic surgery. In this context, orthopedic surgeons must understand the unique considerations when treating patients with HIV, focusing on infection control, treatment outcomes, and perioperative management. 1. Impact of HIV on Bone and Joint Health HIV itself can directly influence musculoskeletal health. Chronic HIV infection and its associated antiretroviral therapy (ART) may result in bone mineral density (BMD) loss, increasing the risk of fractures and osteoporosis. Some ART medications, particularly protease inhibitors and tenofovir, are linked to decreased BMD and bone density, which can exacerbate musculoskeletal issues. Additionally, patients with HIV are at higher risk for avascular necrosis (AVN) of the hip, a condition that can result in joint degeneration and necessitate joint replacement. Osteomyelitis, both acute and chronic, is also more prevalent in HIV-infected individuals, given their compromised immune system. The challenge of diagnosing and treating osteomyelitis in this population may involve more aggressive antibiotic regimens and prolonged recovery times. These musculoskeletal conditions demand a tailored approach to surgery, preoperative management, and rehabilitation. 2. Preoperative Considerations When preparing for surgery, it is crucial to assess the HIV patient's viral load and CD4 count, as these are strong predictors of infection risk and surgical outcomes. A high viral load or low CD4 count indicates immunocompromise, which increases susceptibility to postoperative infections. Ideally, surgery should be delayed until viral suppression is achieved, and CD4 counts are above 200 cells/mm³, the threshold that suggests sufficient immune function. Patients should also be evaluated for comorbidities such as hepatitis B or C, tuberculosis, or other opportunistic infections that may affect the surgical process. Preoperative imaging is essential for assessing bone integrity, particularly if there are concerns about AVN or osteomyelitis. Additionally, multidisciplinary coordination with an HIV specialist is vital to ensure optimal management of ART and any necessary adjustments during the perioperative period. 3. Infection Control in the Operating Room Given the risk of bloodborne transmission of HIV, infection control protocols are paramount in the operating room (OR). While the risk of transmitting HIV through surgical procedures is extremely low, rigorous adherence to standard precautions is essential. This includes the use of appropriate personal protective equipment (PPE), safe needle handling, and meticulous surgical techniques to minimize tissue trauma and the risk of postoperative infection. Moreover, HIV-positive patients are at heightened risk for post-surgical infections due to immune suppression. Prophylactic antibiotics may be used, though they should be chosen carefully to avoid interactions with ART medications. Postoperative monitoring should be more frequent, with a focus on early detection of signs of infection, wound healing issues, and other complications. 4. Postoperative Care and Rehabilitation Postoperative recovery in HIV-positive patients can be more complicated, particularly if the patient has a low CD4 count or high viral load. These patients may experience delayed wound healing, increased risk of surgical site infections (SSIs), and prolonged recovery periods. Additionally, ART side effects, such as gastrointestinal upset or hepatotoxicity, may further complicate the postoperative course. Physical therapy and rehabilitation must be adjusted to the individual needs of the patient, with attention to potential bone loss, muscle wasting, and the risk of fractures. Careful monitoring of ART adherence is also important, as interruptions in treatment can lead to viral rebound, which can significantly impact recovery and the risk of infection. 5. Long-Term Outcomes and Considerations HIV-positive patients who undergo orthopedic surgery often face a prolonged recovery process, especially if their immune system is not fully optimized. However, with the right management, many HIV-positive individuals can achieve successful surgical outcomes. A well-coordinated approach between the orthopedic surgeon, HIV specialist, and rehabilitation team is essential to optimize patient care and recovery. Conclusion The management of HIV in orthopedic surgery involves a comprehensive, individualized approach to preoperative assessment, surgical technique, and postoperative care. By considering the effects of HIV and ART on bone health, immune function, and surgical risk, orthopedic surgeons can optimize outcomes for HIV-positive patients. With careful planning and monitoring, many HIV-infected individuals can benefit from successful orthopedic interventions, improving their quality of life and functional outcomes.