HIV-infected patients undergoing surgery may be more likely to develop pneumonia and to die within 12 months of the surgery, according to a report in the December issue of Archives of Surgery.

HIV patients with a preoperative viral load of greater than 30,000 per milliliter have the greatest increased risk of surgical complications.

Development of highly effective antiretroviral therapy (HAART) has caused HIV to become a chronic condition which allows HIV-infected patients to undergo surgical procedures to correct ailments that would not have been treated previously.

Michael A. Horberg, M.D., M.A.S., and colleagues at Kaiser Permanente Medical Care Program–Northern California studied surgical outcomes in 332 HIV-infected patients undergoing surgical procedures (including abdominal, orthopedic and heart surgeries) between 1997 and 2002. For comparison, the researchers selected a group of 332 of non-HIV patients undergoing a similar procedure that were matched by age and sex.

Most complications, including infections and delayed wound healing, occurred equally in patients with and without HIV. However, more HIV patients developed pneumonia (2.4 percent vs. 0.3 percent) and more died within 12 months (3 percent vs. 0.6 percent) compared to Non-HIV patients.

The researchers also examined risk factors, including CD4 cell count and viral loads, for complications and death among HIV patients. HIV patients with a CD4 count of less than 50 cells per cubic millimeter of blood or having viral loads of greater than 30,000 had the most number of complications. Anti-retroviral therapy did not appear to be related to a greater risk of developing complications.

The authors concluded that a higher HIV viral load seems to be a better predictor of surgically related complications than either the CD4 cell count or the presence or absence of HAART use. In addition, it was noted that HIV patients are living longer and will require surgical attention and therefore adequate viral control is necessary to reduce risks of surgical complications.

Sources:

JAMA and Archives Media Release

Surgical Outcomes in Human Immunodeficiency Virus–Infected Patients in the Era of Highly Active Antiretroviral Therapy. Arch Surg. 2006;141:1238-1245.

About the Author

Jeanne Bohm, Ph.D. is a cancer biologist by training, a medical writer and an experienced science educator.

The author has no financial relationship to any of the companies listed in the article.

 

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Topics #HIV #Pneumonia #Surgical Complications #Viral Load