Predictors of operative outcome in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome

BACKGROUND: Plasma viral load has recently been associated with clinical ou tcome in patients with human immunodeficiency virus (HIV) infection and acq uired immunodeficiency syndrome (AIDS), We hypothetized that, in addition t o CD4 lymphocytes, plasma HIV-1 RNA counts are predictive of postoperative outcome. METHODS: HIV-infected and AIDS patients admitted to a major teaching hospit al requiring invasive or surgical procedures were retrospectively analyzed for postoperative outcome. Preoperative and postoperative immune cell count s including plasma HIV-1 RNA counts were recorded. Chi-square analysis, Fis her's exact test, and multivariate regression were performed with statistic al significance P less than or equal to 0.05. RESULTS: Fifty-five consecutive patients between 14 and 62 years of age wer e admitted in a 1-year period and underwent 64 diagnostic and therapeutic p rocedures. Fourteen (22%) postoperative infections and 18 (28%) complicatio ns other than infection, with an overall mortality of 11%, were documented. Total preoperative white blood cell count ([WBC] P < 0,01), preoperative p ercent lymphocyte count (P < 0.01), absolute postoperative CD4 lymphocyte c ount (P < 0,01), and postoperative plasma viral load (P < 0.0001) are assoc iated with mortality. Multivariate regression indicated that postoperative percent CD4 lymphocyte count is an independent predictor of both postoperat ive infection and other complications (P < 0.05, R = 0.848, power = 0.9911) , while the decrement in percent CD4 lymphocyte count is an independent pre dictor of postoperative complications other than infection (P < 0.05, R = 0 .596, power = 0.7838). CONCLUSIONS: In accordance with the medical literature for clinical outcome in HIV-infected and AIDS patients, both immune cell counts and HIV-1 RNA c ounts were found to associate with postoperative mortality, However, the po stoperative and decrement in percent CD4 lymphocyte proved to be the indepe ndent predictors of postoperative complications. Am J Surg, 2000; 180: 228- 233, (C) 2000 by Excerpta Medica, Inc.