Skip to main content Accessibility help
×
Hostname: page-component-7479d7b7d-c9gpj Total loading time: 0 Render date: 2024-07-12T04:31:16.070Z Has data issue: false hasContentIssue false

22 - Medical care of the HIV-infected surgical patient

Published online by Cambridge University Press:  12 January 2010

Jeffrey L. Lennox
Affiliation:
Emory University, School of Medicine, Atlanta, GA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
Get access

Summary

The epidemic of HIV infection that began in the late twentieth century has become one of the dominant health issues worldwide for the early twenty-first century. In the developed world, advances in the treatment of HIV infection have dramatically extended the lifespan of infected patients. As a result of these therapeutic advances, deaths from HIV infection in the USA fell by over 50% between 1995 and 2000. In developing areas of the world, HIV continues to spread among sexually active adults and their offspring. In some areas of Africa as much as 20% of the adult population is infected. HIV infection rates are also accelerating in the developed nations of Asia, and in areas of the former Soviet Union. The combined effects of increased longevity and accelerated worldwide dissemination are likely to result in increasing opportunities for internists and surgeons to collaborate in the management of HIV-infected patients.

The clinical course of HIV infection has been well described and should be familiar to most general internists. HIV infection is associated with abnormalities in the number and function of CD4 positive T-lymphocytes. Because the CD4 positive lymphocytes are essential to the regulation of the human immune system, progressive immune dysfunction is a natural consequence of HIV infection in most patients. This progressive immune dysregulation is associated with decreased cell-mediated immune function, alterations in the humoral immune response, chronic inflammation and depressed mucosal immunity.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
, pp. 307 - 316
Publisher: Cambridge University Press
Print publication year: 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Guidelines for the use of antiretroviral agents among HIV-infected adults and adolescents: recommendations of the panel on clinical practices for treatment of HIV. http://AIDSinfo.nil.gov.
Beherns, G., Schmidt, H., Meyer, D.et al. Vascular complications associated with use of HIV protease inhibitors. Lancet 1998; 351: 1958.CrossRefGoogle Scholar
Allison, G. T., Bostrom, M. P., & Glesby, M. J.Osteonecrosis in HIV disease: epidemiology, etiologies, and clinical management. AIDS 2003; 17(1): 1–9.CrossRefGoogle ScholarPubMed
The data collection on adverse events of anti-HIV drugs Study Group. Combination antiretroviral therapy and the risk of myocardial infarction. N. Engl. J. Med. 2003; 349: 1993–2003.CrossRef
Sempowski, G. D. & Haynes, B. F.Immune reconstitution in patients with HIV infection. Ann. Rev. Med. 2002; 53: 269–284.CrossRefGoogle ScholarPubMed
Ferguson, C. M.Surgical complications of human immunodeficiency virus infection. Am. Surg. 1988; 54(1): 4–9.Google ScholarPubMed
Wexner, S. D., Smithy, W. B., Trillo, C.et al. Emergency colectomy for cytomegalovirus ileocolitis in patients with the acquired immune deficiency syndrome. Dis. Colon Rectum 1988; 31(10): 755–761.CrossRefGoogle ScholarPubMed
Robinson, G., Wilson, S. E., & Williams, R. A.Surgery in patients with acquired immunodeficiency syndrome. Arch. Surg. 1987; 122(2): 170–175.CrossRefGoogle ScholarPubMed
Whitney, T. M., Brunel, W., Russell, T. R.et al. Emergent abdominal surgery in AIDS: experience in San Francisco. Am. J. Surg. 1994; 168: 239–243.CrossRefGoogle ScholarPubMed
Bizer, L. S., Pettorino, R., & Ashikari, A.Emergency abdominal operations in the patient with acquired immunodeficiency syndrome. J. Am. Coll. Surg. 1995; 180: 205–209.Google ScholarPubMed
Flum, D. R., Steinberg, S. D., Sarkis, A. Y.et al. Appendicitis in patients with acquired immunodeficiency syndrome. J. Am. Coll. Surg. 1997; 184: 481–486.Google ScholarPubMed
Ricci, M., Puente, A. O., Rothenberg, R. E.et al. Open and laparoscopic cholecystectomy in acquired immunodeficiency syndrome: indications and results in fifty-three patients. Surgery 1999; 125(2): 172–177.CrossRefGoogle ScholarPubMed
Harris, H. W. & Schecter, W. P. Emergency abdominal surgery. In Flum, D. R. & Wallack, M. K., eds. The Role of Surgery in AIDS: an Outcomes-based Approach. Baltimore: Lippincott, Williams & Wilkins, 1999.Google Scholar
Buehrer, J. L., Weber, D. J., Meyer, A. A.et al. Wound infection rates after invasive procedures in HIV-1 seropositive versus HIV-1 seronegative hemophiliacs. Ann. Surg. 1990; 211: 492–498.CrossRefGoogle ScholarPubMed
Emparan, C., Iturburu, I. M., Oritz, J.et al. Infective complications after abdominal surgery in patients infected with human immunodeficiency virus: role of CD4 + lymphocytes in prognosis. World J. Surg. 1998; 22: 778–782.CrossRefGoogle ScholarPubMed
Ganesh, R., Castle, D., McGibbon, D.et al. Staphylococcal carriage and HIV infection. Lancet 1989; 2: 558.CrossRefGoogle ScholarPubMed
Kalmeijer, M. D., Coertjens, H., Nieuwland-Bollen, P. M.et al. Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin. Infect. Dis. 2002; 35(4): 353–358.CrossRefGoogle Scholar
VandenBergh, M. F., Kluytmans, J. A., Hout, B. A.et al. Cost-effectiveness of perioperative mupirocin nasal ointment in cardiothoracic surgery. Infect. Control Hosp. Epidemiol. 1996; 17(12): 786–792.CrossRefGoogle ScholarPubMed
Perl, T. M., Cullen, J. J., Wenzel, R. P.et al and the mupirocin and the risk of Staphylococcus aureus study team. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N. Engl. J. Med. 2002; 346(24): 1871–1877.CrossRefGoogle ScholarPubMed
Albaran, R. G., Webber, J., & Steffes, C. P.CD4 cell counts as a prognostic factor of major abdominal surgery in patients infected with the human immunodeficiency virus. Arch. Surg. 1998; 133: 626–631.CrossRefGoogle ScholarPubMed
Rose, D. N., Collins, M., & Kleban, R.Complications of surgery in HIV-infected patients. AIDS 1998; 12: 2243–2251.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Guidelines for preventing opportunistic infections among HIV-infected persons – 2002 recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America. Morb. Mortal. Wkly Rep. 2002; 51(No. RR-8): 1–51.
Saif, M. W., Bona, R., & Greenberg, B.AIDS and thrombosis: retrospective study of 131 HIV-infected patients. AIDS Patient Care Stds 2001; 15(6): 311–320.CrossRefGoogle ScholarPubMed
Patton, L. L. & Horst, C.Oral infections and other manifestations of HIV disease. Infect. Dis. Clin. North Am. 1999; 13(4): 879–900.CrossRefGoogle ScholarPubMed
Seoane, L., Shellito, J., Welsh, D.et al. Pulmonary hypertension associated with HIV infection. South. Med. J. 2001; 94(6): 635–639.CrossRefGoogle ScholarPubMed
Lewis, W. & Dalakas, M. C.Mitochondrial toxicity of antiviral drugs. Nature Med. 1995; 1(5): 417–422.CrossRefGoogle ScholarPubMed
Henrey, K., Melroe, H., Huebsch, J.et al. Severe premature coronary artery disease with protease inhibitors. Lancet 1998; 351: 1328.CrossRefGoogle Scholar
Fortgang, I. S., Belitsos, P. C., Chaisson, R. E.et al. Hepatomegaly and steatosis in HIV-infected patients receiving nucleoside analog antiretroviral therapy. Am. J. Gastroenterol. 1995; 90: 1433–1436.Google ScholarPubMed
Carr, A.Lactic acidemia in Human Immunodeficiency Virus. Clin. Infect. Dis. 2003; 36(Suppl 2): S96–S100.CrossRefGoogle ScholarPubMed
Luzzati, R., Bravo, del P., Perri, Di G.et al. Riboflavin and severe lactic acidosis. Lancet 1999; 353: 901–902.CrossRefGoogle ScholarPubMed
Patrick, L.Nutrients and HIV: Part three: N-acetylcysteine, alpha-lipoic acid, L-glutamine, and L-carnitine. Alt. Med. Rev. 2000; 5(4): 290–305.Google ScholarPubMed
Nash, J. A. & Cohen, S. A.Gallbladder and biliary tract disease in AIDS. Gastroenterol. Clin. North Am. 1997; 26(2): 323–335.CrossRefGoogle Scholar
French, A. L., Beaudet, L. M., Benator, D. A.et al. Cholecystectomy in patients with AIDS: clinicopathologic correlations in 107 cases. Clin. Infect. Dis. 1995: 21: 852–858.CrossRefGoogle ScholarPubMed
Ricci, M., Puente, A. O., Rothenberg, R. E.et al. Open and laparoscopic cholecystectomy in acquired immunodeficiency syndrome: indications and results in fifty-three patients. Surgery 1999; 125(2): 172–177.CrossRefGoogle ScholarPubMed
Rasmussen, L., Zipeto, D., Wolitz, R. A.et al. Risk for retinitis in patients with AIDS can be assessed by quantitation of threshold levels of cytomegalovirus DNA burden in blood. J. Infect. Dis. 1997; 176(5): 1146–1155.CrossRefGoogle ScholarPubMed
Szczech, L. A.Renal diseases associated with human immunodeficiency virus infection: epidemiology, clinical course, and management. Clin. Infect. Dis. 2001; 33(1): 115–119.CrossRefGoogle ScholarPubMed
Merigan, T. C., Bartlett, J. G., & Bolognesi, D. eds. Textbook of AIDS Medicine, 2nd edn. Baltimore: Lippincott Williams & Wilkins, 1999.Google Scholar
Centers for Disease Control and Prevention. Surveillance of health care workers with HIV/AIDS. http://www.cdc.gov/hiv/pubs/facts/hcwsurv.htm.
Cardo, D. M., Culver, D. H., Ciesielski, C. A.et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N. Engl. J. Med. 1997; 337: 1485–1490.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. Morb. Mortal. Wkly Rep. 2001; 50(No. RR-11): 1–52.

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×