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HIV reduces bone mineral density, mineralization, and turnover and may impair fracture healing. This prospective cohort study in South Africa investigated whether HIV infection was associated with impaired fracture healing after trauma. All adults with acute tibia and femur fractures who underwent intermedullary (IM) nailing for fracture fixation between September 2017 and December 2018, at 2 tertiary hospitals, were followed up for a minimum of 12 months postoperatively. The primary outcome was delayed bone union at 6 months (defined by t