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World Journal of Surgery

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01-07-2015 | Original Scientific Report

CD4 Count is Still a Valid Indicator of Outcome in HIV-Infected Patients Undergoing Major Abdominal Surgery in the Era of Highly Active Antiretroviral Therapy

Authors: A. Chichom-Mefire, M. Azabji-Kenfack, J. Atashili

Published in: World Journal of Surgery | Issue 7/2015

Abstract

Background

Patients with HIV/AIDS on antiretroviral therapy (ART) live longer and now require surgery for indications similar to those described for the general population. They have been previously reported to carry higher mortality and complication rates, especially septic complications. The aim of this study was to compare the outcome of major abdominal surgery in three groups of patients with different CD4 counts.

Methods

This is a prospective study comparing HIV-negative patients and two groups of HIV-infected patients on ART with different CD4 counts. The primary outcomes considered were mortality and complication rates after abdominal surgery. We emphasised on the value of CD4 as a predictor of outcome and the impact of the indication for surgery (septic versus non-septic).

Results

We included 63 patients (21 per group). The majority of patients (71 %) were operated on as an emergency and the indications were similar in all groups. The overall and the septic complication rates were both higher in the group with a low CD4 count. This resulted in a significantly longer admission period but did not result in a higher mortality rate. The duration of ART and the World Health Organisation stage of the disease did not significantly influence surgical outcomes.

Conclusions

HIV-infected patients on ART can now safely undergo major abdominal surgery with encouraging results though still relatively poorer than those of HIV-negative subjects. CD4 count remains a significant predictor of outcome and patients with a low CD4 count, however, still require closer pre- and post-operative monitoring.

Deziel DJ, Hyser MJ, Doolas A et al (1990) Major abdominal operations in acquired immunodeficiency syndrome. Am Surg 56(7):445–450PubMed

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(5):320–326PubMedCrossRef

Wilson SE, Robinson G, Williams RA et al (1989) Acquired immune deficiency syndrome (AIDS). Indications for abdominal surgery, pathology, and outcome. Ann Surg 210(4):428–433 discussion 433–4PubMedCentralPubMedCrossRef

Braitstein P, Brinkhof MW, Dabis F et al (2006) Antiretroviral Therapy in Lower Income Countries (ART-LINC) Collaboration; ART Cohort Collaboration (ART-CC) groups. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet 367(9513):817–824PubMedCrossRef

Saltzman DJ, Williams RA, Gelfand DV et al (2005) The surgeon and AIDS: twenty years later. Arch Surg 140(10):961–967PubMedCrossRef

Lord RV (1997) Anorectal surgery in patients infected with human immunodeficiency virus: factors associated with delayed wound healing. Ann Surg 226(1):92–99PubMedCentralPubMedCrossRef

Emparan C, Iturburu IM, Ortiz J et al (1998) Infective complications after abdominal surgery in patients infected with human immunodeficiency virus: role of CD4 + lymphocytes in prognosis. World J Surg 22(8):778–782. doi:10.1007/s002689900469 PubMedCrossRef

Vipond MN, Ralph DJ, Stotter AT (1991) Surgery in HIV-positive and AIDS patients: indications and outcome. J R Coll Surg Edinb 36(4):254–258PubMed

Cacala 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(1):46–51PubMedCentralPubMedCrossRef

10.

Whitney TM, Macho JR, Russell TR et al (1992) Appendicitis in acquired immunodeficiency syndrome. Am J Surg 164:467–471PubMedCrossRef

11.

Binderow SR, Cavallo RJ, Freed J (1993) Laboratory parameters as predictors of operative outcome after major abdominal surgery in AIDS- and HIV-infected patients. Am Surg 59(11):754–757PubMed

12.

Bizer LS, Pettorino R, Ashikari A (1995) Emergency abdominal operations in the patient with acquired immunodeficiency syndrome. J Am Coll Surg 180(2):205–209PubMed

13.

Chambers AJ, Lord RS (2001) Incidence of acquired immune deficiency syndrome (AIDS)-related disorders at laparotomy in patients with AIDS. Br J Surg 88(2):294–297PubMedCrossRef

14.

Duane TM, Sekel S, Wolfe LG et al (2008) Does HIV infection influence outcomes after trauma? J Trauma 65(1):63–65PubMedCrossRef

15.

Hammoud R, Achrafi H, Menegaux F et al (1995) Abdominal surgical emergencies in human immunodeficiency virus (HIV) infected patients. Apropos of 34 cases. Ann Chir 49(10):922–927PubMed

16.

LaRaja RD, Rothenberg RE, Odom JW et al (1989) The incidence of intra-abdominal surgery in acquired immunodeficiency syndrome: a statistical review of 904 patients. Surgery 105(2 Pt 1):175–179PubMed

17.

Albaran RG, Webber J, Steffes CP (1998) CD4 cell counts as a prognostic factor of major abdominal surgery in patients infected with the human immunodeficiency virus. Arch Surg 133(6):626–631PubMedCrossRef

18.

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(1):60–67PubMedCrossRef

19.

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(3):228–233PubMedCrossRef

20.

Eyskens E (1994) Ethics in actual surgery: the surgeon and HIV seropositive and AIDS patients. Acta Chir Belg 94:189–190PubMed

21.

Savioz D, Chilcott M, Ludwig C et al (1998) Preoperative counts of CD4 T-lymphocytes and early postoperative infective complications in HIV-positive patients. Eur J Surg 164(7):483–487PubMedCrossRef

22.

Burack JH, Mandel MS, Bizer LS (1989) Emergency abdominal operations in the patient with acquired immunodeficiency syndrome. Arch Surg 124:285–286PubMedCrossRef

23.

Whitney TM, Brunel W, Russell TR et al (1994) Emergent abdominal surgery in AIDS: experience in San Francisco. Am J Surg 168(3):239–243PubMedCrossRef

24.

Horberg MA, Hurley LB, Klein DB et al (2006) Surgical outcomes in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy. Arch Surg 141(12):1238–1245PubMedCrossRef

25.

Foschi D, Cellerino P, Corsi F et al (2006) Impact of highly active antiretroviral therapy on outcome of cholecystectomy in patients with human immunodeficiency virus infection. Br J Surg 93(11):1383–1389PubMedCrossRef

26.

Su J, Tsun A, Zhang L et al (2013) Preoperative risk factors influencing the incidence of postoperative sepsis in human immunodeficiency virus-infected patients: a retrospective cohort study. World J Surg 37(4):774–779. doi:10.1007/s00268-013-1915-y PubMedCrossRef

27.

Xia XJ, Liu BC, Su JS et al (2012) Preoperative CD4 Count or CD4/CD8 ratio as a useful indicator for postoperative sepsis in HIV-infected patients undergoing abdominal operations. J Surg Res 174(1):e25–e30PubMedCrossRef

28.

Xia XJ, Liu BC (2011) Predictive value of immunological parameters on sepsis following abdominal operation for patients with HIV infection. Zhonghua Wei Chang Wai Ke Za Zhi 14(7):500–502PubMed

29.

World Health Organization (2006) WHO HIV/AIDS Programme: Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach, 2006 revision. Available: http://www.who.int/hiv/pub/arv/adult/en/index.html. Accessed 12 February 2014

30.

Levy MM, Fink MP, Marshall JC et al (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31(4):1250–1256PubMedCrossRef

31.

Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27(2):97–132PubMedCrossRef

32.

Von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457CrossRef

33.

Dua RS, Wajed SA, Winslet MC (2007) Impact of HIV and AIDS on surgical practice. Ann R Coll Surg Engl 89(4):354–358PubMedCentralPubMedCrossRef

34.

Davidson T, Allen-Mersh TG, Miles AJ et al (1991) Emergency laparotomy in patients with AIDS. Br J Surg 78:924–926PubMedCrossRef

35.

Foo E, Sim R, Lim HY et al (1998) Abdominal surgery in human immunodeficiency virus (HIV) infected patients–early local experience. Ann Acad Med Singapore 27(6):759–762PubMed

36.

Deneve JL, Shantha JG, Page AJ et al (2010) CD4 count is predictive of outcome in HIV-positive patients undergoing abdominal operations. Am J Surg 200(6):694–699PubMedCrossRef

37.

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(3):109–112PubMed

38.

Steinman M, Steinman E, Poggetti RS et al (1996) Abdominal surgical emergencies in patients with acquired immunodeficiency syndrome. Rev Assoc Med Bras 42(1):19–24PubMed

39.

Karpelowsky JS, Leva E, Kelley B et al (2009) Outcomes of human immunodeficiency virus-infected and -exposed children undergoing surgery–a prospective study. J Pediatr Surg 44(4):681–687PubMedCrossRef

40.

Madiba TE, Muckart DJ, Thomson SR (2009) Human immunodeficiency disease: how should it affect surgical decision making? World J Surg 33(5):899–909. doi:10.1007/s00268-009-9969-6 PubMedCrossRef

Title: CD4 Count is Still a Valid Indicator of Outcome in HIV-Infected Patients Undergoing Major Abdominal Surgery in the Era of Highly Active Antiretroviral Therapy
Authors: A. Chichom-Mefire
M. Azabji-Kenfack
J. Atashili
Publication date: 01-07-2015
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2015
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-2994-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

CD4 Count is Still a Valid Indicator of Outcome in HIV-Infected Patients Undergoing Major Abdominal Surgery in the Era of Highly Active Antiretroviral Therapy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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