The association of atrial fibrillation (AF) and neck of femur fractures (NOF) are common in old people, creating a complex clinical scenario with significant implications for morbidity, mortality, and healthcare systems. This narrative review explores the bidirectional relationship between AF and NOF, focusing on shared risk factors, pathophysiological links, and challenges in clinical management, and also reviews the benefit of an orthogeriatric model. Advanced age, frailty, osteoporosis, polypharmacy, and cardiovascular comorbidities predispose patients to both conditions, while AF itself increases fall risk through haemodynamic instability, syncope, and adverse effects of rate- or rhythm-controlling medications. Importantly, the physiological stress of hip fracture and subsequent surgery can precipitate new-onset or worsening AF via inflammatory, neurohormonal, and metabolic mechanisms. The main challenge for ortho-geriatricians lies in anticoagulation management and preoperative and postoperative management. While anticoagulation reduces thromboembolic risk in AF, it increases perioperative bleeding risk in patients with NOF, often leading to delays in surgery that are independently associated with poorer outcomes. This review examines the current evidence regarding perioperative anticoagulation strategies, timing of surgery, and postoperative resumption of therapy. In addition, the review examines important outcome parameters such as mortality, stroke, bleeding, length of hospital stay, and functional recovery. This highlights the importance of not only improving multidisciplinary care involving orthopaedics, cardiology, geriatrics, and anaesthesia to optimise outcomes, but also enhancing risk stratification. Standardised perioperative pathways and integrated geriatric–cardiac assessment may help mitigate complications. Therefore, understanding how AF and NOF interact is key to delivering holistic, patient-centred care for an increasingly elderly population in orthogeriatric wards.

Human Immunodeficiency Virus (HIV) infection is associated with a wide spectrum of urological manifestations, reflecting both the direct effects of viral infection and the indirect consequences of immunosuppression, opportunistic infections, malignancies and long-term combined antiretroviral therapy (cART). This narrative review provides a contemporary, multifaceted overview of the clinical and pathological presentations of urological conditions in people living with HIV (PLWHIV), based on articles published between 1989 and 2025. Conditions discussed include HIV-associated nephropathy (HIVAN), opportunistic genitourinary infections, malignancies such as Kaposi sarcoma and lymphoma, as well as non-infectious complications such as HIV-associated nephropathy and erectile dysfunction (ED). The review highlights the evolving epidemiology of these conditions in the cART era, with a noted decline in opportunistic infections but a rising burden of chronic kidney disease and malignancies, largely due to improved survival and ageing of the HIV-positive population. Pathological insights are explored and discussed, including mechanisms of HIV-associated renal injury, such as direct viral infection of renal epithelial cells and genetic predispositions linked to Apolipoprotein L1 (APOL1) variants. In addition, psychosocial factors, including anxiety, stress, stigma, and alcohol use, are discussed, as they may contribute to late presentation to clinical urology services. The review also considers the challenges faced in low and middle-income countries, the impact of HIV on urological services, and the important role of palliative care in advanced disease. Ultimately, this review underscores the need for early recognition, comprehensive diagnostic and surgical evaluation, and integrated social, psychological, and palliative management strategies tailored to the unique needs of PLWHIV. A deeper understanding of the interplay between HIV, cART, psychosocial determinants, and urological health is essential for improving patient outcomes and guiding future research in this evolving field.