MAJOR SURGERY SEEMS NOT TO INFLUENCE HIV DISEASE PROGRESSION IN HEMOPHILIA PATIENTS

The influence of major surgery on HIV disease progression and decline in CD4(+) cell count was evaluated in 23 seropositive haemophilia pati ents. 24 HIV-infected patients served as non-operated controls. In add ition, 32 age-matched seronegative subjects were included. The follow- up time was up to 5 years. During the course of the study, eight of th e operated (35%) and 11 of the non-operated (48%) subjects developed H IV-related symptoms (P = 0.267). The relative risk for developing HIV- related symptoms after surgery was 0.60 (95% CI 0.25; 1.48). A signifi cant decline in CD4(+) cell counts was observed in both the surgery (4 .0 x 10(6)/l/month, 95% CI 2.0; 6.0 x 10(6), P = 0.001) and the non-su rgery (4.0 x 10(6)/l/month, 95% CI 2.0; 6.0 x 10(6), P = 0.004) seropo sitive subgroup, but no difference between the two subgroups was seen (P = 0.793). HIV (6.0 x 10(6)/l/month, 95% CI 2.1 9.9 x 10(6), P = 0.0 005) but not surgery (-1.0 x 10(6)/l/ month, 95%CI -3.0; 0.96 x 10(6), P = 0.647) was an independent predictor for the decline in CD34(+) ce ll count. No interaction effect was observed between HIV infection and surgery (P = 0.361), The annual amount of factor concentrate used for regular replacement therapy did not influence the decline in CD4(+) c ell count (P = 0.492). We conclude that major surgery may be considere d in symptom-free HIV-seropositive haemophilia patients, with CD4(+) c ell counts greater than or equal to 0.20 x 10(9)/l under similar premi ses as for seronegative subjects.