Effect of CD4+ T-lymphocyte count on hospital outcome of elective general thoracic surgery patients with human immunodeficiency virus

• Published in: General thoracic and cardiovascular surgery 2011-11, Vol.59 (11), p.743-747
• Main Authors: Nagasaka, Satoshi, Yazaki, Hirohisa, Ito, Hideyuki, Oka, Shin-ichi, Kuwata, Hiromi, Seike, Ayako, Kitazawa, Shinsuke, Fukuda, Shoji, Hosaka, Shigeru
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antiretroviral Therapy, Highly Active; Biomarkers - blood; Cardiac Surgery; Cardiology; CD4 Lymphocyte Count; Child, Preschool; Elective Surgical Procedures; Female; HIV; HIV - genetics; HIV - immunology; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - mortality; HIV Infections - virology; Human immunodeficiency virus; Humans; Immune system; Japan; Lymph Node Excision - adverse effects; Lymph Node Excision - mortality; Lymphocytes; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Original Article; Patient Selection; Pneumonectomy - adverse effects; Pneumonectomy - mortality; Pneumonia; Postoperative Complications - etiology; Retrospective Studies; Risk Assessment; Risk Factors; RNA, Viral - blood; Surgical Oncology; Thoracic Surgery; Thoracic Surgery, Video-Assisted - adverse effects; Thoracic Surgery, Video-Assisted - mortality; Time Factors; Treatment Outcome; Viral Load; Young Adult
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-011-0808-y

Purpose Traditionally, the chief surgical indicator for human immunodeficiency virus (HIV)-infected patients was the CD4-positive T-lymphocyte count; however, there is no current consensus. Reports published after 2006 indicated that HIV-infected patients had a higher incidence of postoperative pneumonia and higher 12-month mortality rates. In addition, CD4 counts had no relation to the in-hospital outcome. Therefore, we retrospectively examined all of the previous patients who underwent operations in our department on the basis of these findings. Methods Regardless of the initiation of highly active anti-retroviral therapy (HAART), we retrospectively reviewed 10 general thoracic surgeries performed in our department according to the CD4 cell count, HIV-ribonucleic acid (RNA) viral load, time of HAART initiation, operating time, amount of blood, postoperative course, and period of observation. Results There was no incidence of postoperative pneumonia or wound infection. There were also no complications during the perioperative period. One patient died 7 months after surgery. Conclusion Our retrospective study demonstrates that the indicator for elective general thoracic surgery is not the CD4-positive T-lymphocyte count and that the initiation of HAART may reduce the 12-month mortality rates. In HIV-positive patients, regardless of the CD4-positive T-lymphocyte count, surgeons can operate in the same manner as they would with HIV-negative patients.