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Complications Of Surgery In Hiv Infected Patients

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Patient Group And Study Methods

Basics of HIV Infection with Dr. Anupama Raghuram

A retrospective study of SSI was conducted in 242 HIV-infected patients including 17 patients who combined with hemophilia from October 2008 to September 2011 in Shanghai Public Health Clinical Center. SSI were classified according to Centers for Disease Control and Prevention criteria and identified by bedside surveillance and post-discharge follow-up. We stratified and compared the incidence of SSIs according to preoperative CD4 counts with breakpoint values of 200 and wound class. Patients combined with hemophilia were divided into SSIs group and no-SSIs group . Demographic and clinical information was entered into a database that included: type of surgical procedure, age, peripheral blood cells, plasma albumin, CD4 counts, and CD4/CD8 ratios.

Our study was a retrospective study conformed to the tenets of the Declaration of Helsinki. It had been approved by Institutional Ethics Review Board of Shanghai Public Health Clinical Center .

Research Papersurgical Outcomes In Hiv Positive Patients Following Major Surgery At Two Tertiary Institutions In Harare Zimbabwe

Length of hospital stay is increased in HIV positive patients compared to HIV negative patients.

Surgical site infections and pneumonia are the most common complications following major surgery in HIV positive patients.

There is no statistical difference in length of hospital stay in HIV positive patients on HAART or not on HAART.

CD4 count of less than 200 cells/mm3 is associated with increased chances of surgical site infections and pneumonia.

Wound Complications In Hiv

Xin Li, Qiang Zhang*, Changsong Zhao and Rugang Zhao

Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China

*Corresponding author: Qiang Zhang, Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China

Received: August 19, 2014 Accepted: September 11, 2014 September 15, 2014

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Complications Of Common Gynecologic Surgeries Among Hiv

Ana Penman-Aguilar

1National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway-Mailstop K-34, Atlanta, GA 30341, USA

2The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Building 31, Room 2A32, MSC 2425, 31 Center Drive, Bethesda, MD 20892, USA

Academic Editor:

Abstract

1. Introduction

Until recently, most general obstetrician-gynecologists in the United States had little opportunity to provide care to HIV-infected women. Screening guidelines published in 2006 and 2008 and advances in treatment have changed the landscape of treatment and care of HIV-infected women. As more women test positive for HIV and as HIV-infected women live longer, healthier lives , increasing numbers of women of reproductive age will be living with an HIV diagnosis, and general obstetrician-gynecologists will increasingly encounter women who have been diagnosed with HIV infection. Recognizing the increased need for information and guidance for providing optimal gynecologic care for HIV-infected women, the American College of Obstetricians and Gynecologists recently published a practice bulletin on the topic .

2. Materials and Methods

3. Results

Characteristic

Increased Risk: Cd4 Cell Count 3 Viral Load > 30000 Copies/ml

Metabolic and Cardiovascular Complications in HIV/HCV

A CD4 cell count below 50 cells/mm3 was associated with a statistically significant higher complication rate than a CD4 cell count above 50 cells/mm3 . After controlling for viral load, gender, anti-HIV therapy use, HIV risk factor, and ethnicity, this increased the risk of experiencing complications 4.34-fold .

A viral load above 30,000 copies/mL was also associated with increased complications compared to a viral load below 30,000 copies/mL. After controlling for CD4 cell count, gender, HAART use, HIV risk factor, and ethnicity this increased the risk of experiencing complications 2.96-fold .

However, a CD4 cell count below 200 cells/mm3 was not associated with higher complication rates compared with a CD4 cell count above 200 cells/mm3 , and the investigators also found that patients with a history of HAART use within 180 days of surgery had a similar complication rate as patients without a history of HAART use. .

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No Other Differences Seen

The investigators note that although concerns have been raised that HIV-infected patients have longer hospital stays and greater follow-up, affecting outcomes…we found nearly identical numbers of hospital days and surgical follow-up visits in HIV-infected and HIV-noninfected patients.

In fact, no statistically significant differences were found for delayed wound healing, surgical site infections, wound rupture, number of complications, length of hospital stay, number of follow-up visits to the surgeon, or need for further operative procedures to treat surgical complications.

Lung Cancer Surgery In Hiv

Background: The purpose of this study was to investigate the risk factors of postoperative complications and reliable prognostic factors of long-term survival in HIV-infected patients with non-small cell lung cancer .

Methods: HIV-infected patients with NSCLC who underwent surgical treatment were retrospectively studied a single-institutional analysis was conducted from November 2011 to August 2018. Pre- and postoperative clinical data, including age, gender, smoking history, highly active antiretroviral therapy , CD4+ T cell count, HIV viral load, cancer histology, clinical and pathological stage , surgical result, Glasgow Prognostic Score , the Charlson comorbidity index , survival time and postoperative complications were collected.

Results: A total of 33 HIV-infected patients with NSCLC were enrolled of which 18 had preoperative comorbidities and postoperative complications were observed in 22 patients. Thirty-day mortality was not observed in these patients. Median survival time after surgery was 65 months: the MST of p-stage I patients was 65 months p-stage II MST was unestimable p-stage III MST was 21 months. Univariate analyses showed that postoperative complications were associated with HIV viral load , CCI , HAART and CD4+ T cell count . However, multiple logistic regression analysis showed no correlation between HAART and postoperative complications. The p-stage was an independent prognostic factor for survival time.

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What Is Known And Objective

With the advent of antiretroviral therapy and the resultant decrease in mortality among adults living with human immunodeficiency virus , there is now an increased incidence of obesity and obesity-related comorbidities in these patients. Bariatric surgery is becoming an increasingly common treatment option for patients who are classified as clinically obese. There are limited data regarding the use of antiretroviral therapy in patients who have undergone bariatric surgery. The purpose of this review was to evaluate the available literature regarding antiretroviral therapy and pharmaceutical properties in this special population.

Lasik In Patients Hiv Positive Patients

Neurologic Complications of HIV – Ep. 4

There is limited literature evaluating the safety and efficacy of LASIK in patients with HIV positivity but without evidence of AIDS. Anecdotal reports from refractive surgeons indicate the majority believe LASIK can be safely performed in these patients without significant increased risk for infection. Aref et al found that 58% of US practitioners believe HIV positive patients without any AIDS defining characteristics were acceptable candidates for LASIK, while only 14% believed it was an absolute contraindication to surgery.

There is one case report of post-LASIK bilateral bacterial keratitis in an HIV positive patient. Additionally, Aref et al found 3.4% of survey responders reported postoperative keratitis in HIV positive patients, although the total number of cases was not reported. One survey responder reported an incidence of delayed wound healing and dry-eye.

There are no reports of HZO, HSV keratitis or CMV retinitis following LASIK in this patient population.

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Pneumonia Seen More Frequently In Hiv

The only complication that was seen more frequently among the HIV-positive patients was pneumonia . The eight incidences of bacterial pneumonia were resolved with antibiotics. However, one additional HIV-positive patient developed PCP and died 43 days after the surgical procedure.

Lasik In Patients With Aids

There are no studies on the safety and efficacy of LASIK surgery in patients with HIV positivity who meet the defining criteria for AIDS . In the observational study conducted on HIV+ patients undergoing refractive surgery, none of the patients who had complications had CD4 count< 200/mm3 at the time of the surgery although prior history of AIDS was identified as a risk factor for complications in univariate analysis.

Aref et al found that refractive surgeons are much less likely to perform elective LASIK on this patient population than on those with HIV positivity without evidence of immunosuppression. Only 12.5% of responders believe AIDS patients are acceptable candidates for refractive surgery, while the vast majority believes it to be a relative or absolute contraindication.

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Increased Risk Of Wound Complications And Poor Healing Following Laparotomy In Hiv

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Elective Surgery: Determine Hiv Clinical Status

(PDF) Rotator cuff repair in HIV

Preoperative evaluation: All standard preoperative assessments should be performed in patients with HIV, including cardiovascular and pulmonary evaluations such as the Revised Cardiac Risk Index and the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator scores. Individuals with HIV tend to have earlier and more comorbidities than those without HIV, including coronary artery disease, thromboembolic events, and pulmonary complications . As with all patients, a detailed assessment of social support, housing, and food security is required to determine the level of assistance needed for optimal postoperative recovery.

In patients with HIV, clinicians should review the most recent CD4 cell count and HIV viral load test results as part of the preoperative evaluation. If recent test results are available in the patients medical records, retesting before surgery is unnecessary. For most individuals taking ART, current guidelines recommend CD4 count testing every 12 months if a patients CD4 count is < 350 cells/mm3 and HIV viral load testing at least every 6 months . In those with viral suppression and a CD4 count > 350 cells/mm3, CD4 count monitoring is optional.

KEY POINT
  • In individuals with controlled HIV and higher CD4 counts, the risk of surgical complications and postoperative mortality is approximately the same as in individuals without HIV.

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Asian Journal Of Case Reports In Surgery

Asian Journal of Case Reports in Surgery,Page 179-183:29 December 2021

Abstract

Aim: To highlight the presentation and endovascular management of a leaking subclavian artery aneurysm in a patient with human immunodeficiency virus infection.

Background: The presentation of human immunodeficiency virus infection and its complications continue to be an ever-evolving diagnostic challenge for physicians all over the globe. Patients in the younger age group with de novo peripheral arterial aneurysms occasionally present with alarming complications. Subclavian artery aneurysm is one such entity which can be treated successfully with endovascular techniques.

Case Description: 45 yr. old diabetic female patient initially treated for upper respiratory tract infection later presented with a swelling in the right lower neck region. The cervical lymph node biopsy and blood tests confirmed positive for human immunodeficiency virus. She had spontaneous bleeding from the neck region and an urgent angiography revealed a leaking aneurysm at the origin of the right subclavian artery. This was treated with endovascular technique by using a covered stent and also sealing the retrograde flow from the vertebral artery.

Keywords:

References

  • Abstract View: 5 times

Complications Of Surgery For Hiv Patients

OAKLAND, Calif. — HIV-infected patients having surgery were more likely to develop post-op pneumonia or to die within 12 months than matched non-infected patients, researchers here reported.

OAKLAND, Calif., Dec. 19 — HIV-infected patients having surgery were more likely to develop post-op pneumonia or to die within 12 months than matched non-infected patients, researchers here reported.

A pre-op viral load of 30,000/mL or more was associated with almost three times the rate of complications, according to a report in the December issue of Archives of Surgery.

Although complication rates were higher for those with a CD4 cell count of less than 50/L, counts above this level did not affect outcomes, said Michael Horberg, M.D., of the Kaiser Permanente Medical Care Program — Northern California, and colleagues.

To our knowledge, this study is the largest analysis of surgical outcomes for HIV-infected patients compared with matched non-infected patients in the modern era of highly active antiretroviral therapy , Dr. Horberg said.

In the study, 332 HIV-infected patients were matched 1:1 with HIV-non-infected patients who had a variety of surgical procedures from 1997 to 2002. The pairs had similar comorbidities, length of hospital stay, and number of postoperative surgical visits .

More than 95% of the patients were followed by means of health-plan records for 12 postoperative months or until their deaths. Data were analyzed using the Fisher exact test and logistic regression.

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Substantial Weight Loss Can Reduce Risk Of Severe Covid

by Cleveland Clinic

A Cleveland Clinic study shows that among patients with obesity, prior weight loss achieved with bariatric surgery was associated with a 60% lower risk of developing severe complications from COVID-19 infection. The research was published in the journal JAMA Surgery.

Numerous studies have established obesity as a major risk factor for developing serious illness from an infection of SARS-CoV-2, the virus that causes COVID-19. Obesity weakens the immune system, creates a chronic inflammatory state, and increases risk for cardiovascular disease, blood clots, and lung conditions. All of these conditions can complicate COVID-19.

The aim of this study was to examine whether a successful weight-loss intervention in patients with obesity prior to contracting COVID-19 could reduce the risk of developing a severe form of this disease.

“The research findings show that patients with obesity who achieved substantial and sustained weight loss with bariatric surgery prior to a COVID-19 infection reduced their risk of developing severe illness by 60 percent,” said Ali Aminian, M.D., lead author of the study and director of Cleveland Clinic’s Bariatric & Metabolic Institute. “Our study provides strong evidence that obesity is a modifiable risk factor for COVID-19 that can be improved through a successful weight-loss intervention.”

Explore further

Lasik In Patients With Hiv/aids

Complications: TORCH Infections, Chlamydia, Gonorrhea, HIV/AIDS – Maternity Nursing – Level Up RN

There is very little data available on the safety and efficacy of LASIK in HIV positive patients. Currently, the US FDA considers HIV positivity a relative contraindication to refractive surgery, and the American Academy of Ophthalmology has no official opinion.

There are two primary concerns that led to the US FDA issuing their recommendation: the risk of infection in immunosuppressed patients, and the risk of viral transmission via the laser.

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What Is New And Conclusion

Due to the physiologic changes and postoperative management following bariatric surgery, evaluation of the patientsâ medication regimens must be considered and several factors should be taken into account when choosing the appropriate antiretroviral regimen for these patients. Furthermore, communication between the patientsâ surgeon, HIV provider and a clinical pharmacist should occur prior to surgery to ensure the patient is optimized to achieve the best outcome including maintaining virologic suppression.

Lasik Surgery In Hiv Positive Patients

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When HIV was first recognized by the Center for Disease Control 30 years ago, it was considered a lethal disease. Since that time, advances in research, and the development of highly active anti-retroviral therapy have resulted in the transition of HIV from a deadly illness to a chronic disease. The World Health Organization estimates that advances in HIV treatment have added 14.4 million life years to patients with HIV worldwide.

As HIV/AIDS patients live significantly longer lives, more patients are requesting LASIK refractive surgery to address visual acuity issues. The United States FDA recommendations list HIV infection as a relative contraindication for LASIK surgery however a number of practitioners believe that LASIK can be safely and effectively performed in HIV positive patients, so long as patients are appropriately selected, and practitioners adhere diligently to universal precautions.

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Hiv Patients Have Increased Risk Of Pneumonia Death Following Surgery

Date:
JAMA and Archives Journals
Summary:
HIV-infected patients undergoing surgical procedures may be more likely to develop pneumonia after surgery and to die within 12 months than those without HIV, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals. In addition, HIV patients with a preoperative viral load greater than 30,000 per milliliter appear to have increased risk of surgical complications.

HIV-infected patients undergoing surgical procedures may be more likely to develop pneumonia after surgery and to die within 12 months than those without HIV, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals. In addition, HIV patients with a preoperative viral load greater than 30,000 per milliliter appear to have increased risk of surgical complications.

Since the development of medication regimens known as highly active antiretroviral therapy , HIV has become a chronic, manageable condition, according to background information in the article. “Consequently, many HIV-infected patients elect to undergo surgical procedures to correct physical ailments that would not have been treated previously, and undergo operative interventions in lieu of medical therapies for certain conditions,” the authors write.

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Nucleoside/nucleotide Reverse Transcriptase Inhibitors

(PDF) Severe Necrotizing Periodontitis in HIV

3.1.1 Abacavir

The site of absorption for abacavir is likely the proximal small intestine and is thought to be the duodenum. Abacavir is rapidly and extensively absorbed. Therapeutic drug monitoring data are lacking for this agent. An alternative formulation available for abacavir is the oral solution.

3.1.2 Emtricitabine

3.1.3 Lamivudine

3.1.4 Tenofovir disoproxil fumarate

3.1.5 Zidovudine

The primary site of absorption for zidovudine is likely the small intestine, although more specific data are lacking for this agent. There are limited data to suggest that serum levels of zidovudine are not compromised in patients with HIV following Roux-en-Y gastric bypass. However, this finding is challenged by a case report of a 27-year-old pregnant woman with HIV infection who underwent Roux-en-Y bypass surgery. The zidovudine trough level at 12 hours following administration was 8.64 ng/mL on a dose of 300 mg twice daily. Despite this finding, the patient was able to maintain viral suppression throughout her pregnancy. Zidovudine is also currently available as an oral syrup.

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