HIV Serostatus Should Not Be a Criterion for or Against Surgery

http://www.medscape.com/viewarticle/549771

By Megan Rauscher

NEW YORK (Reuters Health) Dec 21 - HIV serostatus should not be a criterion used to decide for or against surgery, researchers conclude based on a retrospective study of 332 HIV-infected and HIV-noninfected pairs of patients. However, optimizing the CD4 count and getting the viral load as low as possible before surgery is best, they note.

In their analyses, HIV-infected patients relative to their HIV-negative counterparts had the same overall rates of surgical complications, including wound infection, need for repeat surgery, general postoperative infection, and wound dehiscence, Dr. Michael A. Horberg from Kaiser Permanente Medical Center in Oakland, California and colleagues report in the December Archives of Surgery.

"Further, we found no greater length of hospital stay for the HIV-infected patients, nor did they have more frequent follow-up visits to the surgeon, meaning they were getting the same amount of care as their HIV-negative counterparts," Dr. Horberg told Reuters Health.

The HIV-infected patients did have a statistically greater number of pneumonias postoperatively than the HIV-negative patients, but the number of cases was small, Dr. Horberg said. There were 8 cases of pneumonia among the HIV-infected group and 1 among the HIV-negative group.

"At 12 months out, there were more deaths among the HIV-infected patients compared to the HIV-negative patients (10 deaths vs. 2)," Dr. Horberg noted, "but looking at the causes of death, we really did not think these deaths were surgically related."

"Interestingly," he said, "the HIV-infected patients who had cardiothoracic surgery (19 cases) seemed to do better than their HIV-negative counterparts."

Having a high viral load (> 30,000 copies/mL) predicted a higher complication rate, as did having a low CD4 T-cell count ( <>

The significance of this study, the authors note, lies in its size - it is believed to be the largest analysis of surgical outcomes for HIV-infected patients in the modern HAART era -- as well as the varieties of common operations represented, and the matching of HIV-positive with HIV-negative patients.

Arch Surg 2006;141:1238-1245.