Effect of emergency major abdominal surgery on CD4 cell count among HIV positive patients in a sub Saharan Africa tertiary hospital - a prospective study

Gabriel Okumu,Moses Galukande,Andrew Kambugu,Patson Makobore,Sam Kaggwa

doi:10.1186/1471-2482-13-4

Gabriel Okumu, Moses Galukande + Show 3 more

Open Access

https://doi.org/10.1186/1471-2482-13-4

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Journal: BMC surgery	Publication Date: Feb 26, 2013
Citations: 12	License type: cc-by

Affiliation: Kisiizi Hospital, Makerere University

Abstract

BackgroundSurgery plays a key role in HIV palliative care, specifically in the diagnosis and treatment of HIV related and non-related conditions. Yet major surgery depresses the immune system. Whereas the surgical consequences of HIV infection are well described, there is a paucity of published data, in resource-limited settings, on the effects of major surgery on the immune system. The purpose of this study was to determine the effect of major abdominal surgery on CD4 count in HIV positive and HIV negative patients after emergency major surgery.MethodsA prospective cohort study was done for patients who underwent emergency major abdominal surgery. Their peri-operative CD4 counts were done for both HIV- and HIV + patients. Median CD4s were used in analysis.Mann Whitney test of significance was used for continuous data and Fisher’ exact test used for categorical data. IRB approval was obtained.ResultsA total of 101 patients were recruited, 25 HIV positive and 76 HIV negative. The median CD4 cell reduction was higher in the HIV negative group (−68 cells) than HIV positive group (−29 cells) (p = 0.480).There was a general increase in the median CD4 change by 72 cells for the HIV positives and 95 cells for the HIV negatives (p = 0.44). CD4 change rose in both the HIV positive and negative groups by 27 cells for the HIV positives and 28 cells for the HIV negatives (p = 0.94). Relative Risk was 0.96, {CI 0.60 – 1.53}.ConclusionMajor emergency abdominal surgery had no significant effect on CD4 cell count among HIV positive patients.

Highlights

Surgery plays a key role in Human immunodeficiency virus (HIV) palliative care, in the diagnosis and treatment of HIV related and non-related conditions
Of the 110 patients who were enrolled in the study 82 were HIV negative and 28 were HIV positive
Of the 82 HIV negative patients 6 were lost to follow up, leaving 76 patients and of the 28 HIV positive patients 3 were lost to follow up leaving 25 whose data was included in the analysis (Table 1)

Summary

Introduction

Surgery plays a key role in HIV palliative care, in the diagnosis and treatment of HIV related and non-related conditions. Whereas the surgical consequences of HIV infection are well described, there is a paucity of published data, in resource-limited settings, on the effects of major surgery on the immune system. Over 40 million people worldwide are believed to be living with HIV or AIDS [1]. HIV/AIDS remains a global problem despite all the effort and vast amount of money spent on controlling it in the last two decades. HIV is a Lentivirus, a subgroup of retroviruses. This family of viruses is known for latency, persistent viremia, infection of the nervous system, and weak host immune responses. HIV has high affinity for CD4 T lymphocytes and monocytes. HIV binds to CD4 cells and becomes

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