The human immunodeficiency virus (HIV), a retrovirus containing single-stranded
ribonucleic acid (RNA), causes
HIV infection, and if left
untreated, can lead to acquired
immunodeficiency syndrome
(AIDS). HIV attacks the CD4
cells (T cells) of the immune
system, which help the immune
system fight off infections. If
left untreated, a person is more
prone to infections or infection-related cancers. Unlike other
viruses, the human body cannot
completely eradicate HIV,
even with treatment. Once a
patient has an HIV infection,
he or she has it for life.
So, although there is no cure
for HIV, with proper medical
treatment, it can be controlled.
HIV transmission and treatment
HIV is transmitted through
unprotected sexual intercourse;
transfusion of contaminated
blood or blood products,
contaminated sharp instruments,
and from mother to baby during
pregnancy, childbirth, and
breastfeeding. HIV infection
is treated with antiretroviral
therapy (ART). With proper
compliance and when taken
every day, this medicine can
significantly prolong the
lives of many people infected
with HIV, keeping them
healthy and reducing the risk
of spreading the infection.
ART was introduced in the
mid-1990s. Until then, HIV
infection rapidly progressed
to end-stage AIDS within a
few years. Today, if diagnosed
with HIV before the disease is
in an advanced stage, patients
on ART can live nearly as long
as uninfected individuals.
1
More than 1. 1 million
people living in the U.S. have
HIV, and one out of seven are
unaware that they have been
infected. From 2008 to 2014, the
estimated number of annual HIV
infections in the U.S. declined
18 percent. The southern states
bear the greatest burden,
accounting for 50 percent of
the new cases reported in 2014.
The most at-risk population
is young, gay, and bisexual
African-American men.
2
HIV/AIDS remains a
significant global public health
challenge, especially in low-and middle-income countries.
According to the World Health
Organization, at the end of
2015, approximately 36. 7 million
people were living with HIV,
and by mid-2016, 18. 2 million
people (less than half) were
on ART. Nearly 80 percent
of pregnant women living
with HIV are on ART.
3
To examine the occurrence
of injured patients with a
diagnosis of HIV in the National
Trauma Data Bank® (NTDB®)
research dataset admission year
2015, medical records were
searched using the International
Classification of Diseases, Ninth
and Tenth Revision, Clinical
Modification codes. Specifically
searched were records that
contained either diagnosis
codes of 042/B20, B21, B22, B23,
B24 (HIV disease), or V08/Z21
(asymptomatic HIV/seropositive).
A total of 34 records were
found, of which 27 contained a
discharge status, including 24
patients discharged to home and
two to acute care/rehab; one died
(see Figure 1, page 65). Of these
patients, 73 percent were men,
on average 47. 4 years of age, had
an average hospital length of
stay of 4. 9 days, an intensive care
unit length of stay of 4. 2 days, an
average injury severity score of
9. 8, and were on the ventilator
for an average of 6. 6 days.
Take care
Health care workers, especially
those who care for acutely
injured patients, often work
with limited patient history
information and must be
prepared to offer intervention
of extreme acuity and time
Gone retroviral: Trauma and HIV
NTDB DATA POINTS
by Richard J. Fantus, MD, FACS
