The prevalence of HIV seropositivity in some trauma population including burns has been reported to be higher than in general population and thus presents an occupational hazard to healthcare workers who care for these patients . The overall seroprevalence of HIV infection in our study was 13.1% that is higher than that in the general population in Uganda (6.5%) ; these may be attributed to high percentage of the risk factors for HIV infection reported in the present study population. Similar observations were also reported by other studies [15–17]. This implies that health care workers who care for burn patients are at high risk of HIV transmission due to frequent contact with body fluids starting from the Acute & Emergency department to wards and in operating theatres. The overall HIV seroprevalence in our study may actually be an underestimate and the magnitude of the problem may not be apparent because many cases (22 patients) were excluded from the study due to failure to meet the inclusion criteria.
Our seroprevalence of HIV in the present study was found to be slight higher than that reported in Malawi reflecting difference in the overall prevalence of HIV infection in general population from one country to another . The prevalence of HIV infection in adult above 15 years and in children 15 years and below in the present study was comparable to that reported in Malawian study . The HIV prevalence in children ≤15 years of age is most likely caused by vertical transmission or by blood transfusion for malaria-related anemia
Our study showed a female preponderance which is in contrast to other studies which reported male preponderance [6, 18]. We could not establish the reasons for this gender difference.
Large number of HIV positive patients with clinical stage I (asymptomatic HIV infected patients) in our study was also reported by other studies [6, 19]. Large number of asymptomatic HIV infected burn injury patients in our study highlights the importance of prevention and strict use of universal precautions among health care workers who care for these patients.
The Centers for Disease Control and Prevention (CDC) recommends routine screening for HIV with informed consent, for patients between 15 to 54 years of age in regions of high HIV prevalence . In Mulago hospital, burn injury patients are not routinely screened and therefore little is known about the magnitude of the problem and the risk of HIV transmission among health care workers who care for these patients.
Compliance with universal precautions has been reported to reduce the risk of HIV transmission among trauma (including burn) health care workers. However, recent studies have shown that compliance with universal barrier precautions in the high-risk setting of emergency rooms, surgical suites, and critical care units in developing countries like Uganda is less than optimal [9–12]. This observation may be attributed to lack of knowledge of universal precautions and limited resources.
Compliance with universal precautions thus becomes an important issue, and determining the reasons for failure to comply with universal precautions becomes an important priority as well [9, 11, 12].
Human immunodeficiency virus infection has been reported to have an impact on the outcome of burn injuries [5, 6, 19]. In the present study, HIV positive individuals had significantly lower CD4 counts than HIV negative patients; the later been attributed to the effect of burn alone and HIV-infected burn patients be immunosuppressed both from the HIV infection as well as from the burn itself, both factors adding increased risk of death in particular of sepsis. In our study, both HIV status and TBSA were found to be independent predictor of CD4 count which is in agreement with James et al  in Malawi. HIV positive patients with burns are more likely to be more profoundly immunosuppressed compared with HIV negative burn patients, caused by the HIV infection as well as by (the extent of) the burn. The TBSA of the burn remains the most important predictor of outcome regardless of HIV status .
Infection rates and bacterial profile between HIV positive patients and HIV negative patients in the present study revealed no significant difference. Similar trend of infection rates and bacterial profile was also reported by other studies [6, 21]. Despite the above observations, the authors of the present study still believe that burn wound sepsis still contributes significantly to high morbidity and mortality among burn injury patients.
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 [18, 22, 23]. The present study showed no significant difference in skin graft take and the degree of healed burn on discharge. This is in agreement with the report from other studies [6, 22] but in contrast to the report of Delaney et al  who described delayed wound healing, opportunistic infections and skin graft loss in HIV-infected burns patients.
The present study revealed no significant difference in the time spent as an inpatient between those who were HIV positive and the controls. Similar findings were also reported by other studies [6, 19].
Due to the poor socio-economic conditions in Uganda, the duration of inpatient stay for our patients may be longer than expected. However this is a problem in both the study and control group.
Our mortality rate for HIV positive was significantly higher than that of HIV negative patients (29.4% versus 8.8%). These mortality figures were comparable to that reported by one study . The mortality rate for HIV positive patients with stigmata of AIDS in this study was 83.3% lower that reported in a study in South Africa (100%) . There was no significant difference between HIV positive patients with CD 4 count ≥ 200 cells/ μl and HIV negative patients. This observation reflects that the prognosis of HIV positive patients with CD 4 count ≥ 200 cells/ μl is similar to that of HIV negative patients. Our CD4 profile and its influence on the outcome of burned patients were comparable to that reported in the Malawian study .
Despite limited follow-up time and difficult to diagnose HIV infection in its early stage ("window period"), the study has shown that the outcome in burn patients is dependent upon multiple variables and not the underlying immunodeficiency (i.e. HIV seropositivity and CD4+ cell count) alone. Other factors influencing the outcome of trauma patients include age of the patient, inhalation injury, TBSA etc.