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Perioperative Antiretroviral Regimen for HIV/AIDS Patients Who Underwent Abdominal Surgery

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Abstract

Background

A short interruption of antiretroviral therapy (ART) and reduced oral bioavailability of antiretroviral medications could occur in perioperative human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients who undergo abdominal surgery. Therefore, we focused on the changes in HIV viral load and CD4+ T lymphocyte count in HIV/AIDS patients after surgery and explored whether the perioperative use of intravenous antiretroviral drugs is beneficial in lowering the viral load and increasing the safety of the surgery.

Methods

We prospectively collected data from HIV/AIDS patients who underwent abdominal surgery at our institution from January 2019 and April 2019. According to the use of different antiretroviral medications during the perioperative period, the HIV/AIDS patients were divided into four groups: Group I: Patients continued their original antiretroviral medications; Group II: Patients received their original antiretroviral medications plus intravenous administration of the fusion inhibitor albuvirtide (ABT); Group III: Patients received ABT alone; and Group IV: Patients did not receive ART. The primary outcomes considered were the changes in HIV load and CD4+ T lymphocyte count and the postoperative complications in the four groups.

Results

A total of 64 HIV/AIDS patients were enrolled, and their data were analyzed descriptively. There were no differences between group I and group II in terms of the changes in viral load. The viral load continued to decrease in group III within 30 days after surgery, especially from D7 to D30 (t = 2.179, p = 0.043). However, the viral load showed an upward trend after surgery in group IV. There were statistically significant differences between the two groups in the changes in viral load after surgery (p = 0.022). However, there were no statistically significant differences between group III and group IV in the postoperative changes in the CD4+ T lymphocyte count. Seven out of 64 patients had postoperative infective complications. The incidence of complications from high to low was as follows: group IV > group I > group III > group II (p < 0.05).

Conclusions

A short perioperative interruption of ART may have a small impact on viral load in HIV/AIDS patients on virologic suppression after abdominal surgery. For patients with a detectable viral load, an intravenous injection of ABT in the perioperative period can reduce the viral load quickly, lower the occurrence of postoperative complications, and increase operation safety for both the HIV/AIDS patient and the surgeons.

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References

  1. Chinese Center for Disease Control and Prevention (2018) The national epidemic of AIDS and STDs in the third quarter of 2018. Zhongguo Ai Zi Bing Xing Bing 24:1075 (in Chinese)

    Google Scholar 

  2. Lucas S, Nelson AM (2015) HIV and the spectrum of human disease. J Pathol 235(2):229–241

    Article  CAS  PubMed  Google Scholar 

  3. Feng T, Feng X, Jiang C, Huang C, Liu B (2015) Sepsis risk factors associated with HIV-1 patients undergoing surgery. Emerg Microbes Infect 4:e59

    CAS  PubMed Central  PubMed  Google Scholar 

  4. Dua RS, Wajed SA, Winslet MC (2007) Impact of HIV and AIDS on surgical practice. Ann R Coll Surg Engl 89(4):354–358

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. World Health Organization (2015) Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. World Health Organization, Geneva

    Google Scholar 

  6. Stakenborg N, Gomez-Pinilla PJ, Boeckxstaens GE (2017) Postoperative ileus: pathophysiology, current therapeutic approaches. Handb Exp Pharmacol 239:39–57

    Article  CAS  PubMed  Google Scholar 

  7. Mythen MG (2009) Postoperative gastrointestinal tract dysfunction: an overview of causes and management strategies. Cleve Clin J Med 76(Suppl 4):S66–S71

    Article  PubMed  Google Scholar 

  8. Cimino C, Binkley A, Swisher R, Short WR (2018) Antiretroviral considerations in HIV-infected patients undergoing bariatric surgery. J Clin Pharm Ther 43(6):757–767

    Article  PubMed  Google Scholar 

  9. Clutter DS, Jordan MR, Bertagnolio S, Shafer RW (2016) HIV-1 drug resistance and resistance testing. Infect Genet Evol J Mol Epidemiol Evol Genet Infect Dis 46:292–307

    CAS  Google Scholar 

  10. Marcellin F, Spire B, Carrieri MP, Roux P (2013) Assessing adherence to antiretroviral therapy in randomized HIV clinical trials: a review of currently used methods. Expert Rev Anti-infect Ther 11(3):239–250

    Article  CAS  PubMed  Google Scholar 

  11. Skiest DJ, Su Z, Havlir DV, Robertson KR, Coombs RW, Cain P et al (2007) Interruption of antiretroviral treatment in HIV-infected patients with preserved immune function is associated with a low rate of clinical progression: a prospective study by AIDS Clinical Trials Group 5170. J Infect Dis 195(10):1426–1436

    Article  CAS  PubMed  Google Scholar 

  12. Li JZ, Etemad B, Ahmed H, Aga E, Bosch RJ, Mellors JW et al (2016) The size of the expressed HIV reservoir predicts timing of viral rebound after treatment interruption. Aids 30(3):343–353

    CAS  PubMed  Google Scholar 

  13. Kilby JM, Bucy RP, Mildvan D, Fischl M, Santana-Bagur J, Lennox J et al (2006) A randomized, partially blinded phase 2 trial of antiretroviral therapy, HIV-specific immunizations, and interleukin-2 cycles to promote efficient control of viral replication (ACTG A5024). J Infect Dis 194(12):1672–1676

    Article  CAS  PubMed  Google Scholar 

  14. Wilen CB, Tilton JC, Doms RW (2012) HIV: cell binding and entry. Cold Spring Harb Perspect Med 2(8):a006866

    Article  PubMed Central  PubMed  Google Scholar 

  15. Saag MS (2012) New and investigational antiretroviral drugs for HIV infection: mechanisms of action and early research findings. Top Antivir Med 20(5):162–167

    PubMed  Google Scholar 

  16. Zhang H, Jin R, Yao C, Zhang T, Wang M, Xia W et al (2016) Combination of long-acting HIV fusion inhibitor albuvirtide and LPV/r showed potent efficacy in HIV-1 patients. AIDS Res Ther 13:8

    Article  PubMed Central  PubMed  Google Scholar 

  17. Albaran RG, Webber J, Steffes CP (1998) CD4 cell counts as a prognostic factor of major abdominal surgery in patients infected with the human immunodeficiency virus. Arch Surg 133(6):626–631

    Article  CAS  PubMed  Google Scholar 

  18. Beccari MV, Mogle BT, Sidman EF, Mastro KA, Asiago-Reddy E, Kufel WD (2019) Ibalizumab, a novel monoclonal antibody for the management of multidrug-resistant HIV-1 infection. Antimicrob Agents Chemother 63(6):e00110

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Lord RV (1997) Anorectal surgery in patients infected with human immunodeficiency virus: factors associated with delayed wound healing. Ann Surg 226(1):92–99

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Emparan C, Iturburu IM, Ortiz J, Mendez JJ (1998) Infective complications after abdominal surgery in patients infected with human immunodeficiency virus: role of CD4? Lymphocytes in prognosis. World J Surg 22(8):778–782. https://doi.org/10.1007/s002689900469

    Article  CAS  PubMed  Google Scholar 

  21. Cacala SR, Mafana E, Thomson SR, Smith A (2006) Prevalence of HIV status and CD4 counts in a surgical cohort: their relationship to clinical outcome. Ann R Coll Surg Engl 88(1):46–51

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Horberg MA, Hurley LB, Klein DB, Follansbee SE, Quesenberry C, Flamm JA et al (2006) Surgical outcomes in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy. Arch Surg 141(12):1238–1245

    Article  PubMed  Google Scholar 

  23. Kim YS, Oka S, Chetchotisakd P, Clarke A, Supparatpinyo K, Avihingsanon A et al (2019) Efficacy and safety of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide in Asian participants with human immunodeficiency virus 1 infection: a sub-analysis of phase 3 clinical trials. HIV Res Clin Pract 8:1–9

    Google Scholar 

  24. Chichom-Mefire A, Azabji-Kenfack M, Atashili J (2015) CD4 count is still a valid indicator of outcome in HIV-infected patients undergoing major abdominal surgery in the era of highly active antiretroviral therapy. World J Surg 39(7):1692–1699. https://doi.org/10.1007/s00268-015-2994-8

    Article  CAS  PubMed  Google Scholar 

  25. Harbell J, Fung J, Nissen N, Olthoff K, Florman SS, Hanto DW, Light J, Bartlett ST, Tzakis AG, Pearson TC, Barin B, Roland ME, Stock PG (2012) HIV-TR investigators. Surgical complications in 275 human immunodeficiency virus (HIV) infected liver and/or kidney transplant recipients. Surgery 152(3):376–381

    Article  PubMed  Google Scholar 

  26. Tran HS, Moncure M, Tarnoff M, Goodman M, Puc MM, Kroon D et al (2000) Predictors of operative outcome in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Am J Surg 180(3):228–233

    Article  CAS  PubMed  Google Scholar 

  27. Foschi D, Cellerino P, Corsi F, Casali A, Rizzi A, Righi I et al (2006) Impact of highly active antiretroviral therapy on outcome of cholecystectomy in patients with human immunodeficiency virus infection. Br J Surg 93(11):1383–1389

    Article  CAS  PubMed  Google Scholar 

  28. Surgical Group of Chinese Association of STD and AIDS Prevention and Control, Surgical Group of Tropical Disease and Parasitology Branch of Chinese Medical Association (2019) Expert consensus on perioperative antiviral therapy for human immunodeficiency virus infected population in China. Chin J Exp Clin Infect Dis (Electronic Edition) 13(1):1–5. (in Chinese)

    Google Scholar 

Download references

Acknowledgements

This work was supported by the Health Planning Committee Project Foundation of Sichuan (Grant Numbers 16PJ079 and 18PJ502).

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Authors and Affiliations

  1. Department of General Surgery, Public Health Clinical Center of Chengdu, Jingju Temple 18#, Chengdu, 610066, China

    Jing Yang, Guo Wei, Yong He, Xin Hua, Shifeng Feng, Yong Zhao, Tingyu Chen, Hua Wang & Liang Guo

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  1. Jing Yang
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Correspondence to Jing Yang.

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Yang, J., Wei, G., He, Y. et al. Perioperative Antiretroviral Regimen for HIV/AIDS Patients Who Underwent Abdominal Surgery. World J Surg 44, 1790–1797 (2020). https://doi.org/10.1007/s00268-020-05402-8

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  • DOI: https://doi.org/10.1007/s00268-020-05402-8

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