ANORECTAL SURGERY IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS -CLINICAL OUTCOME IN RELATION TO IMMUNE STATUS

PURPOSE: Anorectal disease is commonly found in human immunodeficiency virus (HIV)-infected patients. The aim of this study was to determine the spectrum of anorectal disease, its surgical treatment, clinical o utcome, and its relation to immune status. METHODS: Medical records of all HIV-infected patients with anorectal pathology that required surg ical treatment from January 1984 to January 1994 were retrospectively reviewed. Patients were divided into five different groups: common ano rectal pathology (hemorrhoids, polyps, Group A); condylomata acuminata (Group B); perianal sepsis (abscesses, fistulas, Group C); anorectal ulcers (Group D); malignancies (Group E). RESULTS: Eighty-three patien ts needed 204 surgical consultations (13 percent conservative, 87 perc ent operative) for 170 anorectal diseases. Fifty-one patients had mult iple anorectal pathology. Operative intervention resulted in adequate wound healing and symptom relief in 59 percent of patients, adequate w ound healing without relief of symptoms in 24 percent of patients, and disturbed wound healing in 17 percent of patients. Disturbed wound he aling was related to type of anorectal disease (P < 0.001) and to preo perative CD4(+)-lymphocyte counts (P < 0.01). Disturbed wound healing and most insufficient immune status were encountered in Groups C, D, a nd E. Within these groups low CD4(+)-lymphocyte counts were a risk fac tor for disturbed wound healing (P = 0.004). Median postoperative surv ival was highest (4.7 years) in Group A, lowest (0.6 years) in Groups D and E, and related to type of anorectal disease (P = 0.0001). CONCLU SIONS: The spectrum of anorectal disease is complex. Type of anorectal disease is strongly related to immune status, mound healing, and post operative survival.