Early complications of human bites to the hand in HIV-positive patients
Keywords:human bite, hand, HIV, complications, sepsis, infection
BACKGROUND: Human-inflicted bite wounds to the hand are serious injuries that may result in significant morbidity and permanent impairment. Irrespective of the mechanism, they are associated with a high complication rate and this has been attributed to the unique anatomy of the hand and the pathogens involved in human bites. HIV (human immunodeficiency virus) infection is known to compromise the immune system through immune exhaustion and senescence. This potentially increases the risk of complications following human bites to the hand in HIV-positive patients. The aim of this study was to determine if HIV infection is associated with an increased risk for the development of early complications following human bites to the hand.
PATIENTS AND METHODS: We retrospectively reviewed the records of a cohort of consecutive patients treated between June 2013 and October 2014. Patient charts were reviewed and information extracted with regard to demographics, the location and mechanism of the bite, occurrence of complications, HIV status and CD4 counts, as well as whether they were taking ARV (antiretroviral) medication at the time. The time from injury to presentation was recorded, as well as the time from injury to surgical intervention.
RESULTS: Thirty-nine patients were included in the study and there were no exclusions. The mean age of patients was 31.5 years (range 14-60 years), with an approximately equal distribution between males and females. Sixteen patients (41%) in our study cohort were found to be HIV-positive, 15 patients were HIV-negative (38%), and in eight cases (21%) the HIV status was unknown. Of the HIV-positive patients, 44% had CD4 counts below 350 cells/mm3 but only four (25%) were on ART (anti-retroviral therapy) at the time of injury. Complications occurred in 88% (14/16) of the HIV-positive patients compared to 80% (12/15) in the HIV-negative group (risk ratio [RR] = 1.09; 95% confidence interval [CI] = 0.8-1.5; p=0.65.
CONCLUSIONS: HIV infection was not associated with an increased risk of developing complications following human bites to the hand in this series. An increase in the time from injury to presentation was however associated with an increased risk of amputation.