Abstract
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.
Similar content being viewed by others
References
Centers for Disease Control and Prevention’s 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. JAMA 1993;269:729–730.
Cacala SR, Mafana E, Thomson SR, Smith A. Prevalence of HIV status and CD4 counts in a surgical cohort: their relationship to clinical outcome. Ann R Coll Surg Engl 2006;88:46–51.
Horberg MA, Hurley LB, Klein DB, Follansbee SE, Quesenberry C, Flamm JA, et al. Surgical outcomes in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy. Arch Surg 2006;141:1238–1245.
Guidelines for the use of antiretroviral agents in HIV-positive patients (in Japanese). 2010. Available at: http://www.haartsupport.jp.
Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. 2009. Available at: http://www.aidsinfo.nih.gov/guidelines/
Davis PA, Corless DJ, Gazzard BG, Wastell C. Increased risk of wound complications and poor healing following laparotomy in HIV-seropositive and AIDS patients. Dig Surg 1999;16:60–67.
Maiques-Montesinos V, Cervera-Sanchez J, Bellver-Pradas J, Abad-Carrascosa A, Serra-Serra V. Post-cesarean section morbidity in HIV-positive women. Acta Obstet Gynecol Scand 1999;78:789–792.
Vimercati A, Greco P, Loverro G, Lopalco PL, Pansini V, Selvaggi L. Maternal complications after caesarean section in HIV infected women. Eur J Obstet Gynecol Reprod Biol 2000;90:73–76.
Tran HS, Moncure M, Tarnoff M, Goodman M, Puc MM, Kroon D, et al. Predictors of operative outcome in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Am J Surg 2000;180:228–233.
Smirnov GG, Buliskeriia TN, Khachatrian NN, Volodina VN, Arutiunian EN, Lazutkina LI. Surgical interventions in HIV-infected and patients with AIDS. Khirurgiia (Mosk) 2000;7:46–50.
Jones S, Schechter CB, Smith C, Rose DN. Is HIV infection a risk factor for complications of surgery? Mt Sinai J Med 2002;69:329–333.
Madiba TE, Muckart DJ, Thomson SR. Human immunodeficiency disease: how should it affect surgical decision making? World J Surg 2009;33:899–909.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nagasaka, S., Yazaki, H., Ito, H. et al. Effect of CD4+ T-lymphocyte count on hospital outcome of elective general thoracic surgery patients with human immunodeficiency virus. Gen Thorac Cardiovasc Surg 59, 743–747 (2011). https://doi.org/10.1007/s11748-011-0808-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-011-0808-y