Management Algorithm for Surgical Patients Infected with Human Immunodeficiency Virus

Objective: The purpose of this study was to establish the risk factors which influence the postoperative evolution of surgical patients infected with human immunodeficiency virus (HIV), and to conceive a management algorithm based upon these factors.
Methods: We have performed a bidirectional transversal study on a group of 73 HIV-positive patients who had undergone 104 surgical procedures during 2006–2010 in the university medical center of Tîrgu Mureş. We studied risk factors such as the number of CD4 T-cells (LTCD4) < 100/µl, anemia, thrombocytopenia, hypoproteinemia, leukopenia, wasting syndrome, ASA (American Society of Anesthesiologists) score, Altemeier class and NNISS (National Nosocomial Infections Survey Systems) score. We defined any registered postoperative complication, as well as all deaths within the first 30 days from surgery as poor outcome. We used GraphPad statistical program, Fisher test for the statistical analysis of data, we interpreted p <0.05 as statistically significant, for a CI of 95%.
Results: We have registered a total of 15 complications, 5 deaths. Risk factors associated with poor postoperative outcome were LTCD4 <100/µl (p=0.03) wasting syndrome (p=0.0001), ASA score > 1 (p=0.01), Altemeier class > II (p=0.0001), NNISS score 1 (p=0.0001).
Conclusions: HIV-infected patients with emergency surgical pathology will benefit of surgical treatment when the anesthetic risk does not overpass the surgical risk, while patients who require elective interventions will be operated after the correction of risk factors.