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. Surgery deemed safe for HIV patients

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By Christine Dell'amore
Washington (UPI) Dec 18, 2006
HIV-positive patients can expect to recover from surgery as well as uninfected patients, another example of how Americans living with HIV are "approaching normalcy" in most aspects of their lives, researchers said Monday.

After comparing surgery data for both HIV-positive and HIV-negative patients, researchers found complications and death did not differ largely between the two groups, and that simply having HIV should not be a hindrance to either elective or emergency surgery.

"This signifies that overall they're doing a lot better, compared to where we were 10 years ago," said lead author Dr. Michael Horberg, director of HIV/AIDS Policy, Quality and Research for Kaiser Permanente. "It is good news."

The study appeared in the Dec. 18 issue of Archives of Surgery, a publication of the Journal of the American Medical Association.

Thanks to the introduction of modern highly active anti-retroviral therapy, or HAART, in 1996, HIV has shifted from a deadly disease to a "chronic, manageable" condition, researchers say.

The U.S. HIV rate remains the same as it has for more than a decade; about 1.1 million Americans are now infected, and there are about 40,000 new cases of HIV yearly.

Those on treatment usually benefit from more CD4 cells, a type of lymphocyte that fights off viruses and other infections; and lower viral loads, or the amount of HIV copies in the blood. Both are markers of stable health for HIV patients.

Yet many HIV patients still need surgery for physical ailments related to their condition, such as hernia repairs, bowel resections, gall-bladder surgeries and hip-and-joint replacements. Some medications for HIV can decay a person's weight-bearing joints, Horberg said.

Horberg and colleagues surveyed data from 1997 through 2002 on surgeries of 332 pairs of HIV-positive and HIV-negative patients in the Kaiser Permanente Medical Care Program of Northern California. The mean age of both groups was just under 47. The surgeries ranged from chosen procedures, such as knee replacements, to urgent events such as appendectomies and open-heart surgeries.

The researchers "matched" the pairs based on health problems, length of hospital stay, number of doctor visits after surgery, gender and age, among others. In the HIV-positive patients, the average length of infection was 8.4 years. Most of them were on HAART therapy and had high CD4 cell counts and low viral loads.

The research team used statistical tests to compare complications and deaths in the 12 months following surgery. Post-surgery complications include wound infections, longer lengths of stay in the hospital and bacterial infections.

Although Horberg and colleagues found that the HIV-infected patients fared as well as their healthy counterparts, the HIV-positive patients did experience more cases of pneumonia after their operations. Also, more HIV-positive patients died post-operation than the uninfected patients.

However, the number of pneumonia cases was low: 12 HIV-positive patients had it, compared to two patients without HIV. Furthermore, deaths post-operation did not appear to be attributed to surgery, but rather to a pre-existing sickness of the patient. Since surgery raises the risk of pneumonia in any patient, Horberg said the study should underscore the need for good lung care, especially in HIV-positive patients.

Not surprising, HIV-positive patients with lower viral loads and higher CD4 counts had fewer complications and deaths than those with worse health, Horberg found.

Previously, the evidence on surgery success in HIV patients was conflicted, with some studies showing HIV-infected patients had more complications and greater mortality, which caused some surgeons to decide against surgeries for HIV-positive patients. However, other studies have reported successful outcomes.

Horberg and colleagues' study was an observational, retrospective study, which means it may be difficult to replicate the same results in future studies. In addition, in cases of elective surgery, the sicker patients may not have chosen to undergo surgery, the authors point out.

The study comes at a crucial point, as many HIV patients are now readjusting to their everyday routines and living longer.

"As we continue in this era of people beginning to lead normal lives ... we now have the data to say (surgery) is for the most part OK," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

"It's another example of (how) people who are HIV-infected in many areas approach normalcy not only in what they do and feel and respond to, but what they run into in life -- and that includes surgery."

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