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HIV-Positive Patients Can Do Well After Surgery

For some time, many surgeons believed that people with HIV fared worse after surgery than un-infected patients. But Dr. Michael Horberg, who studies HIV patients for the Kaiser Permanente network of hospitals in California, didn't agree. He and his colleagues reviewed the records for 332 HIV-positive patients who'd had surgery between 1997 and 2002. That's the time period when anti-retroviral drug cocktails were beginning to gain wide use.

Horberg wanted to see how HIV-positive patients who had access to these more effective drugs fared after their surgery. He compared them to un-infected patients of the same age and gender, who had the same operations. "Naturally, because this was a generally younger patient population because of the HIV cases, [we saw] a lot of appendectomies, hernia repairs, some gall bladder surgeries, 19 coronary-related surgeries, 4 gynecologic surgeries, and 27 knee or hip replacements."

Horberg found that overall, the patients with HIV did pretty well. "The only difference was that we found - although the numbers were very small, let me stress that - we found a few more pneumonias in the HIV-infected patients, within one year post-op and we found that there were a few more deaths in the HIV-positive patients." But Horberg quickly points out that these were the sickest HIV patients, including individuals with the highest viral loads, or levels of HIV, in their bodies, or whose immune systems were extremely compromised, with low counts of immune cells.

Horberg concludes that doctors should not deny surgery to HIV patients out of fear of doing harm. "If the surgery is urgent, go ahead and do the surgery," he urges, "but pay close attention to the issue of good pulmonary care around the time of surgery. If the surgery is elective, if you can hold off for a little while put them on antiretroviral therapy, get their viral loads under control, and in most cases, that can be done in less than 6 months."

Horberg's research was published in Archives of Surgery.