Human immunodeficiency virus in chronic limb-threatening ischaemia: Risk factors, management, and outcomes: A South African retrospective cohort study

Abstract

Background: People living with human immunodeficiency virus (PLHIV) have an increased risk of chronic limb-threatening ischaemia (CLTI), yet data from sub-Saharan Africa in the modern antiretroviral era remain limited. We estimated the human immunodeficiency virus (HIV) prevalence in patients admitted with index CLTI and compared risk factors and outcomes with those of their seronegative counterparts.
Methods: Retrospective study of adults admitted with CLTI to Tygerberg Hospital (2016–2022). Patients identified via discharge summaries were corroborated with medical records. Clinical and HIV status data were extracted from medical and laboratory records.
Results: Among 1205 patients admitted with index CLTI, the estimated prevalence of HIV was 3.5% (95% CI: 2.5% – 4.7%), with 588 confirmed HIV-negative (48.8%) and 575 with unknown HIV status (47.7%). The PLHIV cohort was 69% male compared to 64% in the HIV-negative group (p = 0.511). The mean age of PLHIV with CLTI was 51 years (± 9 years) compared to 62 years (± 11 years) (p < 0.001). People living with human immunodeficiency virus were less than half as likely to undergo endovascular therapy as their definitive management although not statistically significant (7.1% vs 17.8%; odds ratios: 0.49, 95% CI: 0.13–1.93, p = 0.305). A similar proportion of PLHIV and HIV-negative patients underwent open revascularisation (23.8% vs 22.8%, p = 0.652). Surgical management had similar rates of successful outcomes (defined as below ankle amputation or better, 90% vs 95.5%, p = 0.433). We found no difference in in-hospital mortality rates.
Conclusion: People living with HIV were younger and had fewer risk factors for CLTI than their HIV-negative counterparts. In-hospital revascularisation outcomes, complication rates and mortality were similar.
Contribution: Further study is needed regarding the district hospital HIV burden and long-term outcomes in these patients.