Top

World Journal of Surgery

Published in:

01-05-2009

Human Immunodeficiency Disease: How Should It Affect Surgical Decision Making?

Authors: T. E. Madiba, D. J. J. Muckart, S. R. Thomson

Published in: World Journal of Surgery | Issue 5/2009

Abstract

Background

The ever-increasing prevalence of human immunodeficiency virus (HIV) infection and the continued improvement in clinical management has increased the likelihood of surgery being performed on patients with this infection. The aim of the review was to assess current literature on the influence of HIV status on surgical decision-making.

Methods

A literature review was performed using MEDLINE articles addressing “human immunodeficiency virus,” “HIV,” “acquired immunodeficiency syndrome,” “AIDS,” “HIV and surgery.” We also manually searched relevant surgical journals and completed the bibliographic compilation by collecting cross references from published papers.

Results

Results of surgery between noninfected and HIV-infected individuals and between HIV-infected and acquired immunodeficiency syndrome (AIDS) patients are variable in terms of morbidity, mortality, and hospital stay. The risk of major surgery is not unlike that for other immunocompromised or malnourished patients. The multiple co-morbidities associated with HIV infection and the availability of highly active antiretroviral therapy must be considered when assessing and optimizing the patient for surgery. The clinical stage of the patient’s disease should be evaluated with a focus on the overall organ system function. For patients with advanced HIV disease, palliative surgery offers relief of acute problems with improvement in the quality of life. When indicated, diagnostic surgery assists with further decision-making in the medical management of these patients and hence should not be withheld.

Conclusion

HIV infection should not be considered a significant independent factor for major surgical procedures. Appropriate surgery should be offered as in normal surgical patients without fear of an unfavorable outcome.

Howard RJ (1990) Human immunodeficiency virus testing and the risk to the surgeon of acquiring HIV. Surg Gynecol Obstet 171:22–26PubMed

Harris HW, Schecter WP (1997) Surgical risk assessment and management in patients with HIV disease. Gastroenterol Clin North Am 26:377–391PubMedCrossRef

Pietrabissa A, Merigliano S, Monotrsi M et al (1997) Reducing the occupational risk of infections for the surgeon: multicentric national survey on more than 15,000 surgical procedures. World J Surg 21:573–578PubMedCrossRef

Bender BS, Bender JS (1993) Surgical issues in the management of the HIV-infected patient. Surg Clin North Am 73:373–388PubMed

Buergler JM, Kim R, Thisted RA et al (1992) Risk of human immunodeficiency virus in surgeons, anesthesiologists and medical students. Anesth Analg 75:118–124PubMedCrossRef

Raahave D, Bremmelgaard A (1991) New operative technique to reduce surgeon’s risk of HIV infection. J Hosp Infect 18(Suppl):177–183PubMedCrossRef

Desai DM, Kuo PC (2005) Perioperative management of special populations: immunocompromised host (cancer, HIV, transplantation). Surg Clin North Am 85:1267–1282PubMedCrossRef

Owotade FJ, Ogunbodede EO, Sowande OA (2003) HIV/AIDS pandemic and surgical practice in a Nigerian teaching hospital. Trop Doct 33:228–231PubMed

Babameto G, Kotler DP (1997) Malnutrition in HIV infection. Surg Clin North Am 26:393–415

10.

Čačala SR, Mafana E, Thomson SR et al (2006) Prevalence of HIV status and CD4 counts in a surgical cohort: their relationship to clinical outcome. Ann R Coll Surg Engl 88:46–51PubMedCrossRef

11.

Gerberding JL, Littell C, Tarkington A et al (1990) Risk of exposure of surgical personnel to patients’ blood during surgery at San Francisco General Hospital. N Engl J Med 322:1788–1793PubMed

12.

Chamberland ME, Ciesielski CA, Howard RJ et al (1995) Occupational risk of infection with human immunodeficiency virus. Surg Clin North Am 75:1057–1070PubMed

13.

Lewis DK, Callaghan M, Phiri K et al (2003) Prevalence and indicators of HIV and AIDS among adults admitted to medical and surgical wards in Blantyre, Malawi. Trans R Soc Trop Med Hyg 97:91–96PubMedCrossRef

14.

Consten ECJ, van Lanschot JJB, Henny PC et al (1995) A prospective study on the risk of exposure to HIV during surgery in Zambia. AIDS 9:585–588PubMedCrossRef

15.

Gumodoka B, Favot I, Berege ZA et al (1997) Occupational exposure to the risk of HIV infection among health care workers in Mwanza region, United Republic of Tanzania. Bull World Health Organ 75:133–140PubMed

16.

UNAIDS (2004) Regional HIV and AIDS estimates. www.unaids.org

17.

Bhagwanjee S, Muckart DJ, Jeena PM et al (1997) Does HIV status influence the outcome of patients admitted to a surgical intensive care unit? A prospective double blind study. BMJ 314:1077–1081PubMed

18.

Watters DA (1997) Surgery for tuberculosis before and after human immunodeficiency virus infection: a tropical perspective. Br J Surg 84:8–14PubMedCrossRef

19.

Barnes PF, Le HQ, Davidson PT (1993) Tuberculosis in patients with HIV infection. Med Clin North Am 77:1369–1390PubMed

20.

De Cock KM, Soro B, Coulibay IM et al (1992) Tuberculosis and HIV infection in Sub-Saharan Africa. JAMA 268:1581–1587PubMedCrossRef

21.

Clarke DL, Thomson SR, Bissetty T et al (2007) A single surgical unit’s experience with abdominal tuberculosis in the HIV/AIDS era. World J Surg 31:1087–1098PubMedCrossRef

22.

Edginton ME, Wong ML, Phofa R et al (2005) Tuberculosis at Chris Hani Baragwanath Hospital: numbers of patients diagnosed and outcomes of referrals to district clinics. Int J Tuberc Lung Dis 9:398–402PubMed

23.

Deziel DJ, Hyser MJ, Doolas A et al (1990) Major abdominal operations in acquired immunodeficiency syndrome. Am Surg 56:445–450PubMed

24.

Bizer L, Pettorino R, Ashikari A (1995) Emergency abdominal operations in the patient with acquired immunodeficiency syndrome. J Am Coll Surg 180:205–209PubMed

25.

Yii MK, Saunder A, Scott DF (1995) Abdominal surgery in HIV/AIDS patients: indications, operative management, pathology and outcome. Aust N Z J Surg 65:320–326PubMedCrossRef

26.

Whitney TM, Brunel W, Russell TR et al (1994) Emergent abdominal surgery in AIDS: experience in San Francisco. Am J Surg 168:239–243PubMedCrossRef

27.

Davis PA, Corless DJ, Gazzard BG et al (1999) Increased risk of wound complications and poor healing following laparotomy in HIV-seropositive and AIDS patients. Dig Surg 16:60–67PubMedCrossRef

28.

Ayers J, Howton MJ, Layon AJ (1993) Postoperative complications in patients with human immunodeficiency virus disease: clinical data and a literature review. Chest 103:1800–1807PubMedCrossRef

29.

Horberg MA, Hurley LB, Klein DB et al (2006) Surgical outcomes in human immunodefiency virus-infected patients in the era of highly active antriretroviral therapy. Arch Surg 141:1238–1245PubMedCrossRef

30.

Morandi E, Merlini D, Salvaggio A et al (1999) Prospective study of healing time after haemorrhoidectomy: influence of HIV infection, acquired immunodeficiency syndrome and anal wound infection. Dis Colon Rectum 42:1140–1144PubMedCrossRef

31.

Cappell MS, Geller AJ (1992) The high mortality of gastrointestinal bleeding in HIV-seropositive patients: a multivariate analysis of risk factors and warning signs of mortality in 50 consecutive patients. Am J Gastroenterol 87:815–824PubMed

32.

Parente F, Cernuschi M, Valsecchi L et al (1991) Acute upper gastrointestinal bleeding in patients with AIDS: a relatively uncommon condition associated with reduced survival. Gut 32:987–990PubMedCrossRef

33.

Chalasani N, Wilcox CM (1998) Etiology and outcome of lower gastrointestinal bleeding in patients with AIDS. Am J Gastorenterol 93:175–178CrossRef

34.

Curi MA, Pappas PJ, Silva MB et al (1999) Hemodialysis access: influence of the human immunodeficiency virus on patency and infection rates. J Vasc Surg 29:608–616PubMedCrossRef

35.

George SL, Swindells S, Knudson R et al (1999) Unexplained thrombosis in HIV-infected patients receiving protease inhibitors: report of seven cases. Am J Med 107:624–626PubMedCrossRef

36.

Jacobson MC, Dezube BJ, Aboulafia DM (2004) Thrombotic complications in patients infected with HIV in the era of highly active antiretroviral therapy: a case series. Clin Infect Dis 39:1214–1222PubMedCrossRef

37.

Saif MW, Greenberg B (2001) HIV and thrombosis: a review. AIDS Patient Care STDS 15:15–24PubMedCrossRef

38.

Saber AA, Aboolian A, Laraja RD et al (2001) HIV/AIDS and the risk of deep vein thrombosis: a study of 45 patients with lower extremity involvement. Am Surg 67:645–647PubMed

39.

Saif MW, Bona R, Greenberg B (2001) AIDS and thrombosis: retrospective study of 131 HIV-infected patients. AIDS Patient Care STDS 15:311–320PubMedCrossRef

40.

Nickas G, Wachter RM (2000) Outcomes of intensive care for patients with human immunodeficiency virus infection. Arch Intern Med 160:541–547PubMedCrossRef

41.

Saltzman DJ, Williams RA, Gelfand DV et al (2005) The surgeon and AIDS. Arch Surg 140:961–967PubMedCrossRef

42.

Dua RS, Wajed SA, Winslet MC (2007) Impact of HIV and AIDS on surgical practice. Ann R Coll Surg Engl 89:354–358PubMedCrossRef

43.

Lord RVN (1997) Anorectal surgery in patients infected with human immunodeficiency virus: factors associated with delayed wound healing. Ann Surg 226:92–99PubMedCrossRef

44.

Safavi A, Gottesman L, Dailey TH (1991) Anorectal surgery in the HIV+ patient: update. Dis Colon Rectum 34:299–304PubMedCrossRef

45.

Tran HS, Moncure M, Tarnoff M et al (2000) Predictors of operative outcome in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Am J Surg 180:228–233PubMedCrossRef

46.

Hewitt WR, Sokol TP, Fleshner PR (1996) Should HIV status alter indications for hemorrhoidectomy? Dis Colon Rectum 39:615–618PubMedCrossRef

47.

Consten EC, Slors FJ, Noten HJ et al (1995) Anorectal surgery in human immunodeficiency virus-infected patients: clinical outcome in relation to immune status. Dis Colon Rectum 38:1169–1175PubMedCrossRef

48.

Davis PA, Corless DJ, Aspinall R et al (2001) Effect of CD4(+) and CD8(+) cell depletion on wound healing. Br J Surg 88:298–304PubMedCrossRef

49.

Peterson JM, Barbul A, Breslin RJ et al (1987) Significance of T-lymphocytes in wound healing. Surgery 102:300–305PubMed

50.

Barbul A, Breslin RJ, Woodyard JP et al (1989) The effect of in vivo T helper and T suppressor lymphocyte depletion on wound healing. Ann Surg 209:4979–4983CrossRef

51.

Moenning S, Huber P, Somonton C et al (1991) Prediction of morbidity by T4 lymphocyte count in the HIV positive or AIDS anorectal outpatient [meeting abstract]. Dis Colon Rectum 34:17CrossRef

52.

Narasimhan M, Posner AJ, DePalo VA et al (2004) Intensive care in patients with HIV infection in the era of highly active anti-retroviral therapy. Chest 125:1800–1804PubMedCrossRef

53.

Bozzette SA, Finkelstein DM, Spector SA et al (1995) A randomized trial of three anti-Pneumocystis agents in patients with advanced human immunodeficiency virus infection. N Engl J Med 332:693–699PubMedCrossRef

54.

Gebo KA, Chaisson RE, Folkemer JG et al (1999) Cost of HIV medical care in the era of highly active antiretroviral therapy. AIDS 13:963–969PubMedCrossRef

55.

Gulick RM, Mellors JW, Havlir D et al (1997) Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. N Engl J Med 337:734–739PubMedCrossRef

56.

Hammer SM, Squires KE, Hughes MD et al (1997) A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 counts of 200 per cubic millimeter or less. N Engl J Med 337:725–733PubMedCrossRef

57.

Abbasakoor F, Boulos PB (2005) Anal intraepithelial neoplasia. Br J Surg 92:277–290PubMedCrossRef

58.

International Collaboration on HIV and Cancer (2000) Highly active antiretroviral therapy and the incidence of cancer in human immunodeficiency virus-infected adults. J Natl Cancer Inst 92:1823–1830CrossRef

59.

Morris A, Creasman J, Turner J et al (2002) Intensive care of human immunodeficiency virus-infected patients during the era of highly active antiretroviral therapy. Am J Respir Crit Care Med 166:262–267PubMedCrossRef

60.

Louwagie GM, Bachmann MO, Meyer K et al (2007) Highly active antiretroviral treatment and health related quality of life in South African adults with human immunodeficiency virus infection: a cross-sectional study. BMC Public Health 7:244PubMedCrossRef

61.

Losina E, Anglaret X, Yazdanpanah Y et al (2006) Impact of opportunistic diseases on chronic mortality in HIV infected adults in Côte d’Ivoire. S Afr Med J 96:526–529PubMed

62.

Ministry of Health, SA (2004) Anti-retroviral treatment in adults. http://www.doh.gov.za/docs/factsheets/guidelines/artguidelines04/sec1 2004;1–12 (pdf)

63.

Wakeman R, Johnson CD, Wastell C (1990) Surgical procedures in patients at risk of human immunodeficiency virus infection. J R Soc Med 83:315–318PubMed

64.

Binderow SR, Cavallo RJ, Freed J (1993) Laboratory parameters as predictors of outcome after major abdominal surgery in AIDS and HIV-infected patients. Am Surg 59:754–757PubMed

65.

Devito JR, Robinson WR (1995) Gynecological surgical outcomes among asymptomatic human immunodeficiency virus-infected women and uninfected control subjects. J La State Med Soc 147:109–112PubMed

66.

European HIV in Obstetric Group (2004) Higher rates of post-partum complications in HIV-infected than in uninfected women irrespective of mode of delivery. AIDS 18:935–938

67.

Stawicki SP, Hoff WS, Hoey Ba et al (2005) Human immunodeficiency virus infection in trauma patients: where do we stand? J Trauma 58:88–93PubMedCrossRef

68.

Nadal SR, Manzione CR, Galvão VM et al (1999) Perianal diseases in HIV-positive patients compared with a seronegative population. Dis Colon Rectum 42:649–654PubMedCrossRef

69.

Jjuuko G, Moodley J (2002) Abdominal wound sepsis associated with gynaecological surgery at King Edward VIII Hospital, Durban. S Afr J Surg 40:11–14PubMed

70.

Mkony C, Kwesigabo G, Lyamuya E et al (2003) Prevalence and clinical presentation of HIV infection among newly hospitalised surgical patients at Muhimbili National Hospital, Dar es Salaam, Tanzania. East Afr Med J 80:640–645PubMed

71.

Doumgba AD, Kamoune JN, Ngarhio L et al (2006) Surgery and HIV in Bangui (Central African Republic). Sante 16:173–176PubMed

72.

Martinson NA, Omar T, Gray GE et al (2007) High rates of HIV in surgical patients in Soweto, South Africa: impact on resource utilisation and recommendations for HIV testing. Trans R Soc Trop Med Hyg 101:176–182PubMedCrossRef

73.

Ramogale MR, Moodley J, Sebitloane MH (2007) HIV-associated maternal mortality: primary causes of death at King Edward VIII Hospital, Durban. S Afr Med J 97:363–366PubMed

74.

Fauci AS, Pantaleo G, Stanley S et al (1996) Immunopathogenic mechanisms of HIV infection. Ann Intern Med 124:654–663PubMed

Title: Human Immunodeficiency Disease: How Should It Affect Surgical Decision Making?
Authors: T. E. Madiba
D. J. J. Muckart
S. R. Thomson
Publication date: 01-05-2009
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 5/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-009-9969-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Human Immunodeficiency Disease: How Should It Affect Surgical Decision Making?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2009

Effect of Perioperative Immunosuppressive Medication on Early Outcome in Crohn’s Disease Patients

Clinical Benefits After the Implementation of a Protocol of Restricted Perioperative Intravenous Crystalloid Fluids in Major Abdominal Operations

Choledochoduodenostomy as an Alternative to Choledochojejunostomy in Liver Transplantation

Value of Laparoscopic Appendectomy in the Elderly

Reply

Predictive Factors for Morbidity and Mortality in Patients Undergoing Laparoscopic Paraesophageal Hernia Repair: Age, ASA Score and Operation Type Influence Morbidity