Prospective study of healing time after hemorrhoidectomy - Influence of HIV infection, acquired immunodeficiency syndrome, and anal wound infection

PURPOSE: Hemorrhoids and rectal diseases are very frequent in HIV-positive patients, especially in those with homosexual habits. This study was design ed to compare posthemorrhoidectomy healing time in such patients, and evalu ate the role of various factors related to their HIV-positive status. METHO DS: The study involved a prospective series of 48 male patients (32 HIV-ser opositive and 16 with acquired immunodeficiency syndrome) who underwent hem orrhoidectomy between 1992 and 1996; 20 age-matched and gender-matched sero negative patients were retrospectively identified as controls. Healing time s, postoperative complications, and wound infections were recorded, and the delaying effect of CD4+, Karnofsky Index scores, and HIV-ribonucleic acid were evaluated. Between-group differences were analyzed using Cox's model, Student's t-test, chi-squared test, and Fisher's exact probability test. P values of <0.05 were considered statistically significant. RESULTS: Cox's m odel revealed that HIV positivity and the presence of acquired immunodefici ency syndrome significantly delayed wound healing, which also correlated wi th the presence of infection. The healing rate in HIV-positive patients was 66 percent after 14 weeks and 100 percent after 32 weeks; the correspondin g figures for patients with acquired immunodeficiency syndrome were 0 and 5 0 percent. All of the controls were healed after 14 weeks (P < 0.01 vs. bot h the patients with acquired immunodeficiency syndrome and HIV+ patients). Centers for Disease Control and Prevention HIV-positive status (including C D4+ counts) and the performance status proved to be of prognostic value. CO NCLUSIONS: Our data suggest that the indications for hemorrhoidectomy in pa tients with acquired immunodeficiency syndrome need to be considered extrem ely carefully because of the high incidence of delayed wound healing.