PREOPERATIVE COUNTS OF CD4 T-LYMPHOCYTES AND EARLY POSTOPERATIVE INFECTIVE COMPLICATIONS IN HIV-POSITIVE PATIENTS

Objective: To assess the relationship between postoperative infective complications and the CD4 count. Design: Retrospective and biometric s tudy. Setting: Two university hospitals, Switzerland Subject: 40 HIV-p ositive patients who had had CD4 counts done during the three months b efore operation. Interventions: Clean and contaminated gastrointestina l and orthopaedic procedures. Main outcome measure: Postoperative infe ctive complications. Results: 15 patients developed postoperative infe ctive complications (38%), 6 of which (40%) were HIV-related. CD4 cell count, as well as the type of operation (contaminated or clean), infl uenced the infective complication rate. The risk of infective complica tions after a contaminated procedure when the CD4 count was below 200 mm(3) was more than 50%. In clean operations, even when the CD4 cell c ount was close to 0, the rate of infective complications was never as high as 50%. Patients with a CD4 cell count of 500 or more have a simi lar rate of infective complications as HIV seronegative patients. Conc lusion: Indications for operation in HIV-positive patients must take i nto account the CD4 cell count and the type of operation.