Background: HIV infection has historically been regarded as a risk factor for adverse surgical outcomes, but contemporary evidence from the antiretroviral therapy (ART) era suggests that well-controlled HIV infection may not independently increase perioperative morbidity. Data specific to paediatric and adolescent spinal deformity surgery in high HIV-burden settings remain scarce.

Objectives: To determine the seroprevalence of HIV among adolescents and young adults undergoing posterior instrumented scoliosis correction at a South African tertiary referral centre, and to describe demographic, radiographic, and perioperative characteristics according to HIV status.

Methods: Consecutive adolescents and young adults undergoing primary posterior instrumented spinal fusion for scoliosis between January 2015 and February 2022 at Chris Hani Baragwanath Academic Hospital were identified from a prospectively maintained institutional spinal deformity database. HIV status was determined from routine preoperative serology. Demographic, radiographic, and perioperative variables were compared between HIV-positive and HIV-negative patients using Fisher's exact test and the Mann–Whitney U test, as appropriate. Given the small number of HIV-positive patients, between-group comparisons were considered exploratory and hypothesis-generating.

Results: Forty-three patients met the inclusion criteria (mean age 15.5 ± 3.5 years, range 11–30 years; 37 female [86.0%], 6 male [14.0%]). Two patients (4.7%; 95% CI 0.57–15.81%) were HIV-positive. Baseline Cobb angle (66.1 ± 16.6° versus 70° and 80°, p = 0.38), preoperative haemoglobin (13.61 ± 1.25 versus 13.7 and 14.6 g/dL, p = 0.44), postoperative haemoglobin (10.81 ± 1.48 versus 11.7 and 11.8 g/dL, p = 0.19), and estimated blood loss (746.8 ± 318.8 versus 350 and 500 mL, p = 0.14) did not differ significantly between HIV-negative and HIV-positive patients. Documented medical comorbidity was more frequent among HIV-positive patients (2/2, 100%) than HIV-negative patients (6/41, 14.6%; p = 0.031), although this should be interpreted cautiously given the small subgroup. Overall, 7 of 43 patients (16.3%) experienced a postoperative complication; none occurred in the HIV-positive subgroup.

Conclusions: In this cohort, HIV seroprevalence among adolescents undergoing scoliosis correction was 4.7%, lower than the estimated general-population prevalence in South Africa, likely reflecting careful preoperative patient selection. HIV-positive patients experienced perioperative outcomes comparable with HIV-negative patients. These preliminary, hypothesis-generating findings support the view that well-controlled HIV infection, in isolation, should not be regarded as a contraindication to elective spinal deformity surgery; larger prospective multicentre studies incorporating immunological and virological variables are needed.