[Objective] To explore the efficacy and safety of tranexamic acid in reducing blood loss and incision infection in total hip replacement in people infected with HIV. [Methods] The 59 male patients with HIV infection with femoral head necrosis undergoing total hip replacement from November 2010 to 2010 to September 2020 were selected and divided into TXA and no TXA.Record and compare the time, operation, incision length, blood loss, transfusion rate, incision healing, hospital stay and full weight bearing activity time between the two groups; ultrasound observation; laboratory testing of changes in Hb, Hct, PLT, CRP, ESR and DD. [Results] There was no significant difference in operation time and incision length between the two groups (P> 0.05), however, the TXA group effectively reduced the perioperative blood loss and blood transfusion rate, reducing the length of hospitalization and full weight-bearing activity time (P <0.05); Compared with the incision healing rate between the two groups, 2 cases had B healing in TXA group, 8 cases had B healing and 1 case had C healing in no TXA group, with significant difference (P <0.05). 2 tendon venous thrombosis were added in both groups, with no significant difference (P> 0.05); The levels of 1,3 d Hb and Hct were higher in TXA than those without TXA, and 3,7 d CRP and 7d ESR and DD were lower than those in no TXA, which were significant (P <0.05). [Conclusions] TXA is a safe and effective adjuvant agent in HIV infected patients by reducing the perioperative blood loss and the incision complications and does not increase the incidence of venous thrombosis.