Mandible Fracture Fixation Adverse Outcomes Higher For Patients With Human Immunodeficiency Virus (HIV), Even if on Antiretroviral Therapy

Background: There is limited information on how human immunodeficiency virus (HIV) status correlates with outcomes following craniofacial procedures. The current study aimed to evaluate the relationship between HIV status and outcomes following mandibular fracture open reduction and internal fixation (ORIF) with and without antiretroviral therapy (ART) using a large, national cohort. Methods: Adults (18 y or older) with closed mandible fractures who underwent ORIF within 14 days of diagnosis were identified in the 2010 to 2023 PearlDiver M170 database. HIV status, ART prescriptions, and patient age, sex, insurance status, Charlson Comorbidity Index (CCI), and tobacco use were abstracted. Multivariable logistic regression adjusted for age, sex, CCI, tobacco use, and insurance was used to compare postoperative outcomes for those with and without HIV. A subanalysis for HIV-positive patients on ART was compared with patients without HIV. Results: Among 21,977 patients, HIV was noted for 369 (1.7%), of whom 212 (57.5%) had ART prescriptions. HIV was independently associated with 90-day postoperative ED visits (OR=5.31), malocclusion (OR=3.67), surgical site infections (OR=1.91), and 6-month nonunion (OR=1.90). Relative to patients without HIV, HIV patients on ART had higher odds of 90-day postoperative ED visits (OR=9.87), surgical site infections (OR=2.32), and 6-month nonunion (OR=2.06) compared with HIV-negative controls (All P values <0.05 after Benjamini–Hochberg correction). Conclusions: Following ORIF of mandible fractures, HIV was associated with increased odds of impaired bone healing, infection, and unplanned health care utilization, even in the setting of ART. This may be helpful for patient counseling and surgical planning.