Prevalence of HIV status and CD4 counts in a surgical cohort: their relationship to clinical outcome

• Published in: Annals of the Royal College of Surgeons of England 2006-01, Vol.88 (1), p.46-51
• Main Authors: Cacala, S R, Mafana, E, Thomson, S R, Smith, A
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Age; Age Distribution; Aged; Aged, 80 and over; AIDS; Antiretroviral drugs; CD4 Lymphocyte Count; Clinical outcomes; Clinical trials; Drainage; Electrolytes; Female; HIV; HIV Infections - complications; HIV Infections - immunology; Hospital Mortality; Hospitals; Human immunodeficiency virus; Humans; Infections; Length of Stay; Male; Males; Middle Aged; Ostomy; Patients; Prognosis; Prospective Studies; Sepsis; Sepsis - surgery; Sex Distribution; Surgery; Surgical Oncology; Surgical Procedures, Operative; Trauma; Treatment Outcome; Wound healing; Wounds and Injuries - complications; Wounds and Injuries - surgery
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588406X83050

HIV positivity alone as a predictor of surgical outcome has not been extensively studied in regions of high prevalence. The aim was to determine the prevalence of HIV infection in surgical patients, and compare differences in their clinical course based on their serological status and CD4 counts. A prospective cohort of 350 patients, enrolled over 6 weeks, were studied. HIV status was determined in all patients. HIV-positive patients had CD4 counts. Clinical details were collated with HIV data after completion of enrollment. Of the 350 patients, all but 6 were black South Africans. The median age was 31 years (range, 18-82 years). There were 143 trauma and 207 non-trauma patients. The male:female ratio was 1.4:1. The overall HIV seropositivity rate was 39% (females, 46%; males, 36%). Overall, 228 patients had surgical intervention and 96 patients had drainage of sepsis. The hospital stay (HIV negative, 11.9 +/- 15.9 days; HIV positive, 11.0 +/- 15 days) and mortality (HIV positive, 3.6%; HIV negative, 3.7%) did not differ by major diagnostic category. For HIV-positive patients, the male:female ratio was 1.2:1. There were 54 trauma and 83 non-trauma patients. An operation for the drainage of a septic focus was commoner in the HIV-positive admissions. Thirty-two (24%) patients had CD4 counts less than 200 cells/mm3, (i.e. AIDS). The hospital mortality, hospital stay and severity of sepsis were not related to CD4 counts. HIV status does not influence the outcome of general surgical admissions and should not influence surgical management decisions. In HIV-positive surgical patients, CD4 counts have no relation to in-hospital outcome in a heterogeneous group of surgical patients.