Background: Musculoskeletal infections in patients with the human
immunodeficiency virus (HIV) have been described. However, the prevalence,
specific characteristics, and outcomes of spinal infections in these patients
have not been studied in a large group of patients to our knowledge.
Methods: The computerized records of all patients discharged with
the diagnosis of spinal osteomyelitis, discitis, epidural abscess, or
tuberculosis from our institution from October 1994 through September 2000
were reviewed. Patients with the diagnosis of HIV were identified, and the
charts were examined in detail.
Results: During the six-year period, 7338 unique patients who were
HIV positive were admitted. Seventeen (0.23%) of them were treated for a
spinal infection. The prevalence of spinal infection was 23.2 per 10,000
admissions of HIV-positive patients and 7.1 per 10,000 admissions of
HIV-negative patients (p < 0.0001). Eight patients who had discitis and/or
osteomyelitis had a mean CD4 T-cell count of 339.6 cells/mm3, and
all eight had clinical resolution of the infection after six to twelve weeks
of appropriate antibiotic therapy. In contrast, six patients who had spinal
tuberculosis had a mean CD4 count of 75.7 cells/mm3 (p = 0.005),
and one of them died during the hospitalization. The remaining three patients,
who had epidural abscesses, had a mean CD4 count of 20.67 cells/mm3
(p = 0.001), and two of them died.
Conclusions: Discitis and/or osteomyelitis occurs in HIV-positive
patients with a mild-to-moderate decrease (=200 cells/mm3) in
the CD4 T-cell count, and the infection responds to appropriate antibiotics.
Patients with a more severely decreased CD4 count (50 to 200
cells/mm3) may have spinal tuberculosis develop, and patients with
the lowest CD4 counts are more likely to have epidural abscesses develop. The
three fatalities in this study occurred in these two groups of patients. As a
group, HIV-positive patients are significantly more likely to have a spinal
infection develop than are HIV-negative patients (p < 0.0001). Although the
CD4 count can be used as a predictor of the clinical course, identification of
the organism remains paramount in the treatment of this complex patient
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.