INFECTIVE COMPLICATIONS AFTER ABDOMINAL-SURGERY IN PATIENTS INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - ROLE OF CD4(+) LYMPHOCYTES IN PROGNOSIS

Risk factors associated with surgical infections are related to many e vents that modulate the immune system and affect the surgical procedur e. The aim of this study was to determine the influence of low CD4+ ly mphocyte counts in 24 patients with human immunodeficiency virus (HIV) undergoing abdominal surgery. Blood samples were obtained, and the ly mphocyte population was evaluated perioperatively, as was the nutritio nal status of the patient. All the patients received selective antibio tic prophylaxis depending on the surgical procedure performed: (1) cle an surgery: splenectomies (n = 8); (2) clean-contaminated: cholecystec tomy and biliary tract surgery (n = 8); and (3) contaminated: appendec tomy (n = 8). Depending on their CD4 count, two groups were formed: on e with 200 to 500 cells/ml (n = II) and the other with < 200 cells/ml (n = 13). When surgical infection was suspected, surgical drainage and microbiologic cultures were undertaken. For statistical evaluation of the groups ANOVA and the chi-square test were used; p < 0.05 was cons idered significant. Altogether 14 patients (58.3%) had a wound infecti on, and the mean (+/- SD) CD4 count in those patients was decreased (2 21.7 +/- 75.1) compared with that of the 10 patients in the uneventful group (386 +/- 81.2), Surgical infection rates were 50% for clean pro cedures, 62.5 for clean-contaminated procedures, and 62.5% for contami nated surgery.The group of patients with CD4 counts of < 200 cells/ml had an increased incidence of surgical infection, regardless of the ty pe of surgery (p = 0.002). Thus the surgical infection rates in HIV pa tients undergoing abdominal surgery are dramatically increased. The CD 4 and subsequently depressed neutrophil populations increase the risk of surgical infection during major procedures regardless of the type o f surgery performed.