CARDIOPULMONARY BYPASS IN HIV-POSITIVE PATIENTS

To prove the hypothesis that cardiopulmonary bypass may accelerate the development of acquired immunodeficiency syndrome (AIDS) in the human immunodeficiency virus carrier, the clinical course of 40 patients po sitive for human immunodeficiency virus who underwent cardiac operatio ns between 1986 and 1992 was analyzed, especially in regard to the pro gression to AIDS. Mean age was 30 years (range, 19 to 61 years). Thirt y-four patients (85%) were intravenous drug abusers; in 4 (10%) transm ission of infection was sexual, and in 2 (5%) it was through a contami nated blood transfusion. Valve procedures were performed in 38 patient s (95%), mostly for endocarditis in drug addicts. Hospital mortality w as 20% (8 patients). The 32 survivors have been followed up a mean of 21 months (range, 4 months to 6 years). Four patients (12.5%) experien ced progression to AIDS during the follow-up period. Actuarial progres sion to AIDS is 5% (+/-5%) at 1 year, 20% (+/-10%) at 2 years, and 40% (+/-19%) at 5 years. There have been 8 late deaths (5 due to recurren t endocarditis, 2 due to AIDS, and 1 due to overdose). Actuarial survi val is 79% (+/-8%) at 1 year, 60% (+/-11%) at 2 years, and 48% (+/-14% ) at 5 years. The results indicate that progression to AIDS in the pat ient positive for human immunodeficiency virus is not accelerated by t he use of cardiopulmonary bypass. The poor prognosis in these patients is mainly related to the particular pathological conditions that ofte n affect the drug addict population.