HIV infection reduces skin graft survival in burn injuries: a prospective study

Impaired survival of skin grafts has been noted in human immunodeficiency virus (HIV) infected patients, but the reason is not known. Alterations in inflammatory response, which might be recorded as an imbalance in cytokine production, have been implicated. The aim of this study was to determine the impact of HIV infection in patients with burn injuries by comparison of split skin graft survival, T lymphocyte count and cytokine levels in HIV-infected and non HIV-infected patients in relation to healthy and HIV-infected nonburnt volunteers. Fifty-four patients with deep dermal burns were included. Fifteen patients' were HIV-infected. Thirteen healthy and 15 HIV-infected, volunteers were recruited as controls. The burnt surface area was traced on a transparent plastic sheet and converted to area. Graft survival on day of discharge/regraft for non HIV-infected patients was 69%, and in HIV-infected 22%, (p < 0.05). The median length of hospital stay for early excision among non HIV-infected patients was 21 (12-53) days and for HIV-infected, 41 days (p < 0.05). Serum protein levels in HIV-infected patients were elevated compared to non HIV-infected patients (p < 0.05). CD4+ Lymphocytes were depressed in HIV-infected volunteers and HIV-infected burn patients compared to healthy volunteers (p < 0.05). CD8+ lymphocytes were elevated in HIV-infected volunteers compared to non HIV-infected burn patients. Pro-inflammatory cytokine levels of Interleukin-2 (IL-2), Interteukin-6 (IL-6), Interferon-gama (IFN-gamma) and tumour necrosis factor alpha (TNF-alpha) were depressed in HIV-infected volunteers compared to healthy volunteers and non HIV-infected burn patients. The pro-inflammatory cytokine IFN-gamma did not increase after burn injury in HIV-infected burns patients as did IL-2, IL-6 and TNF-alpha (p < 0.05). Antiinflammatory cytokine levels of IL-4 were elevated in HIV-infected volunteers compared to healthy volunteers and burn patients (p < 0.05). Conclusion: Graft survival after split skin grafting of burn wounds in HIV-infected patients is impaired and hospital stay is prolonged. HIV infection. result in immune dysregulation, which might be related to impaired skin graft survival. (C) 2003 The British Association of Plastic Surgeons. Published by Elsevier Ltd. ALL rights reserved