Surgery and HIV in Bangui (Central African Republic)

Abstract

Routine presurgical testing for HIV is a matter of controversy. The risk of intraoperative contamination and postoperative complications, especially opportunistic infections, justifies this practice. To assess the real prevalence of HIV in surgical departments in the Central African Republic (CAR) and, more precisely, its impact on surgery patients and staff, as well as measures of prevention. This exploratory study took place from September 1st, 2001, through October 31st, 2002, in the general surgery departments of Amitié Hospital in Bangui (CAR). The patients tested were randomly selected after surgery, and their serum tested at the hospital laboratory by ELISA methods. The sample included 207 patients, 58.9% of whom were women. Their average age was 32 years (range: 15-72 years. Surgery was elective for 111 patients (53.6%) (for example, for uncomplicated hernias or gynecological problems) and performed on an emergency basis for 96 (46.4%). The latter included appendectomies (20.3%), laparotomies (14%), and strangulated hernias (12%). Overall, 49 patients (23.6%) were HIV-positive. Wound infection (51 cases) and septic shock (4 cases) were significantly more frequent in HIV-positive than in HIV-negative patients, as was mortality. Patients with HIV developed postoperative complications, but so did HIV-negative patients. Practitioners should stress specific care for HIV-positive patients without insisting on discriminatory testing. Especially important are sterilization of medical and surgical materials, and universal precautions and asepsis, including personal prevention measures for healthcare staff.