SURGERY IN THE HIV POSITIVE PATIENT Dr A Mouton HIV infection continues to be major cause of morbidity and mortality WHO estimate 40 million people world wide infected AIDS now fourth largest cause of death worldwide Sub-Sahara Africa → most common cause of death
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SURGERY IN THE HIV POSITIVE PATIENT
Dr A Mouton
PERI-OPERATIVE GUIDELINES FOR SURGERY
- Prophylactic antibiotics
- ARV therapy regimen
B. Hypokalemia - 2° to vomiting, diarrhoea, and
C. Hypocalemia - Drugs
- Malignancy, CMV
D. Hypo-uricaemia - Assorted opportunistic
infections like CMV
- Indicates ↑ morbidity and
TRAM et al:
JONES et al:
-Impaired immunity a consequence of surgery in HIV (+) patient?
-Does surgical intervention impact on the course of HIV infections?
-HIV (+) patient → on HAART
-Surgery - 50% major procedures
- 50% minor procedures
-Surgery - 50% General surgery
- 25% Gyne
- 25 Other
-Parameters - CD4 count before and after operation
- Viral load
Viral load (within 180 day) - ⅓ had a higher titer post op
- ⅔ unchanged or ↓
HIV (+) patient in term of Immune suppression in HAART era.
dysfunction pre-op did not impact on immune system adversely.
(Determined by CD4 and viral load)
-Gautun et al. (2008) – 43 drug naïve AIDS patients
- mean baseline CD4 count 112
- Follow up after 3 months
- 80% clinical improvement
- CD4 ↑ by > 50 in 85% of cases
- Mean CD4 increases from 112 baseline to 196
Factor associated with ↑ risk for infection
I.) Systematic factors:
ii.) Local factors:
Hair removal with razor
Post irradiation to site
Most complication: (1)CD4 < 200 cell/mm³
(2)Poor nutritional status(↓Alb)
Clinical adrenal insufficiency occurring in 5%
HIV(+) and 20% AIDS patients post-op.
- Approach to patient with fever → determined by presence and nature of surgery and CD4 and viral load.
- Most fevers from common case:
and development of opportunistic infections.
- Late in disease (<CD < 100)
- Stress of surgery – unmask previously unsuspected hypo adrenalism.
- Electrolyte changes (↓Na ↓Ka)