**3.1 Introduction**

After sexual intercourse, blood transfusion had been considered as one the possible pathway HIV contamination. Into the other hand, due acute episodes and chronic anemia, SCD patient had been to be more frequently transfused than normal hemoglobin carriers; it therefore appear rational to hypothesize that SCD patients present a higher risk of HIV infection. The literature on this matter is very scars; and the clinical experience does not confirm this theorical thinking.This may be due to at least a reduction on the transfusion rate in sickles and a better safety of blood banking systems. In the other hand, both HIV &

treatment should be undertaken with normalization of biological markers prior to the joint procedure. After arthroplasty, bone fragments from joint resection and reaming should also be send for bacterial analysis; if positive, a specific antibiotic testing should be undertaken. Subsequently, a long term antibiotic therapy should be undertaken in collaboration with the infectious diseases team, and till the normalization of biological

Finally, arthroplasties of the Hip, the knee, the shoulder or any other joint may commonly be demanded by SCD patients, mainly due the high frequency secondary avascular necrosis as a chronic complication of their genetic condition. The procedure may be performed with at least acceptable results, provided the following precautions are

Conventional biological work-up and especially, the hemoglobin types/ratios, and

Enhancement of the fetal hemoglobin ratio by chronic preoperative administration of

 Enhancement of the total Hemoglobin level to 100G/ml preoperatively, by chronic oral folic acid, and maintaining it so per and post operatively by homologous red blood

Avoiding any acidosis state by blood gas control and correction during the early post

Culture of bone resection/reaming products and subsequent long standing and

After sexual intercourse, blood transfusion had been considered as one the possible pathway HIV contamination. Into the other hand, due acute episodes and chronic anemia, SCD patient had been to be more frequently transfused than normal hemoglobin carriers; it therefore appear rational to hypothesize that SCD patients present a higher risk of HIV infection. The literature on this matter is very scars; and the clinical experience does not confirm this theorical thinking.This may be due to at least a reduction on the transfusion rate in sickles and a better safety of blood banking systems. In the other hand, both HIV &

infectious markers.

properly taken:

cells

**2.5 Section B summary** 

hydroxycarbamide.

operative period

Introduction

**3.1 Introduction** 

comprehensive research of occult infections.

targeted post arthroplasty antibiotic therapy

**3. Section C: Arthroplasty in HIV & SCD carriers** 

Avoiding autologous blood transfusion

Antiretroviral therapy in SCD patients

HIV carriage in SCD patients

Summary of section C

Preoperative treatment of any occult or evident infection

 Optimal oxygenation during the early post operative period Optimal fluid infusion during the early post-operative period Adequate warming during the early post-operative period

SCD have been incriminated as high risk factor or secondary aseptic necrosis, mainly of the hip. Provided the standard treatment of aseptic necrosis of the Hip is total hip arthroplasty, it become evident although rare and not reported currently, combination of both condition (SCD& HIV) in patients demanding arthroplasty, may in the next future, become a challenging issue. There is no evidence base on this precise issue; however, since the above both section A and B have been focused respectively on arthroplasty in HIV carriers in one hand, and in another one, Arthroplasty in SCD, knowing about HIV carriage in SCD patients may help to set up our thinking regarding arthroplasty in patients with both conditions.
