Surgical issues in HIV infection
- Howard Libman, MD
Howard Libman, MD
- Deputy Editor — Primary Care (Adult)
- Professor of Medicine, Emeritus
- Harvard Medical School
Potent antiretroviral therapy (ART) has significantly increased longevity among HIV-infected patients. As this patient population grows older, an increased need for surgical interventions, such as coronary revascularization, will likely rise. (See "HIV infection in older adults".)
This topic review will address issues surrounding HIV infection in the patient who needs surgery, including morbidity and mortality, the pre-operative evaluation, and post-surgical management. This topic will also address concerns regarding HIV transmission during surgical procedures. Discussions of postexposure prophylaxis after potential HIV exposures are discussed elsewhere. (See "Management of healthcare personnel exposed to HIV".)
HIV INFECTION AND SURGICAL MORBIDITY AND MORTALITY
With widespread use of antiretroviral therapy (ART), good surgical outcomes are reported among HIV-infected populations. Some, but not all, studies have suggested a slightly greater morbidity and mortality compared with uninfected populations [1-13]:
●In a retrospective study of United States veterans who underwent inpatient surgery, 30 day postoperative mortality was higher among 1641 HIV-infected patients compared with 3282 procedure-matched, uninfected controls (3.4 versus 1.6 percent) . Although lower CD4 cell counts were associated with higher mortality, the mortality difference between HIV-infected and uninfected patients persisted at all CD4 cell count strata. Hypoalbuminemia and older age were also independently associated with mortality.
●In another retrospective study of surgical outcomes, HIV-infected patients were matched 1:1 by type of surgery, year of intervention, gender, and age with HIV-uninfected patients . Clinical outcomes, length of stay, and number of postoperative visits were similar among the 332 matched patient pairs. Various complications were no more frequent among HIV-infected patients, except for pneumonia.
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Dec 14, 2015.References
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- HIV INFECTION AND SURGICAL MORBIDITY AND MORTALITY
- PREOPERATIVE ASSESSMENT
- General health status
- HIV disease status
- Medication history
- Past medical history
- Nutritional status
- Laboratory assessment
- Advance directives
- PERIOPERATIVE MANAGEMENT
- POSTOPERATIVE MANAGEMENT
- Postoperative fever
- - Common causes
- - Opportunistic infections
- - Pneumonia
- ORGAN TRANSPLANTATION IN HIV-INFECTED PATIENTS
- SURGERY AND HIV TRANSMISSION
- Risk of HIV transmission from patient to healthcare worker
- Risk of HIV transmission from infected healthcare workers to patients
- - Large-scale look-back investigations
- - Management of the HIV-infected healthcare worker
- SUMMARY AND RECOMMENDATIONS