Prevalence of HIV Status and CD4 Counts in a Surgical Cohort: Their Relationship to Clinical Outcome

Abstract

INTRODUCTION 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. PATIENTS AND METHODS 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 enrolment. RESULTS 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. CONCLUSIONS 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.

The effect of HIV status on clinical outcomes of surgical sepsis in KwaZulu-Natal Province, South Africa

“…KwaZulu-Natal (KZN) Province in SA is at the epicentre of this pandemic. [2,3] About 25% of the province's adult population live with the virus, compared with a national average of 18%. [4] In KZN, there are districts with higher rates of infection, e.g.…”

“…[7][8][9][10] Despite the significant prevalence of the disease in KZN, the impact of HIV co-infection on the clinical outcome of surgical patients in our setting remains largely unknown. Over a decade ago, and prior to the national roll-out of the HAART programme, a study by Cacala et al [2] showed that HIV status does not influence the clinical outcome in general surgical patients. Their study included trauma and non-trauma patients, and did not focus solely on the outcome of HIV-infected patients with surgical sepsis.…”

“…[1][2][3] Patients may present with a complication due to their chronic immunosuppressed state or with an unrelated surgical illness. Immunosuppression results in opportunistic infections such as TB and a number of viral infections.…”

Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study

“…The HIV infection rate may not be accurate, as the status was not determined for all patients and unconsented testing is still controversial. The prognostic implications of HIV in surgical patient outcomes have already been explored by some authors, [12][13][14][15] with conflicting results, but were not found to be associated with surgical mortality in SASOS [3] or in patients admitted to critical care units. The sepsis rate in critical care admissions in SA is of concern, with 35.4% of patients having suspected or confirmed infection on ICU admission.…”

The South African Surgical Outcomes Study: A 7-day prospective observational cohort study

“…The contribution of HIV to perioperative outcomes is unclear. [9] The above provided the rationale to conduct a study similar to EuSOS in SA, known as the South African Surgical Outcomes Study (SASOS). The primary outcome was in-hospital mortality.…”