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Surgery Safer for HIV+ Patients Due to New Treatments, Better Health

Posted on: Monday, 18 December 2006, 18:00 CST

OAKLAND, Calif., Dec. 18 /PRNewswire/ -- The modern treatment era of triple-combination AIDS therapies is making it possible for HIV+ patients to safely have surgeries they may not have risked a decade ago, according to a new study by Kaiser Permanente researchers. The study, the largest to date on the topic, appears in the December 18 issue of Archives of Surgery, a JAMA/Archives journal.

Researchers looked at the electronic and print medical records of HIV+ patients to determine how well they did compared with HIV-negative patients following both elective and urgent surgeries.

Researchers found few differences in the post-surgical outcomes between the two groups.

"The commonly held belief that HIV+ patients do worse is probably no longer valid," says lead researcher Michael A. Horberg, MD, MAS, Kaiser Permanente Director of HIV/AIDS Policy, Quality Improvement, and Research. "Our study confirms that surgery is safe for most healthier people who are HIV+." He explains that HIV+ patients are essentially healthier today due to the 1996 advent of Highly Active Anti-Retroviral Therapy (HAART), which combines at least three drugs to control the virus.

"What the results mean for patients who are HIV+ is if there is a need for elective or urgent surgery, in nearly all cases, HIV should not be a reason for holding off on having surgery," says Horberg. Furthermore, he adds, "Most of these patients will have no increased risk of surgical complications compared to their HIV-negative counterparts."

Horberg and the Kaiser Permanente research team analyzed 12-month post- surgical outcomes and mortality rates among 332 pairs of Kaiser Permanente HIV+ and HIV-negative patients. The patients had undergone everything from elective procedures such as hip/knee replacements to more urgent surgeries such as appendectomies from 1997 to 2002.

The HIV+ patients did nearly as well as their HIV-negative counterparts except when it came to pneumonia. The HIV+ patients came down with 12 cases vs. two in the HIV-negative group. Additionally, a small number of those infected with the HIV virus who carried higher viral loads (greater than 30,000 ml) and had a CD4 count under 50 suffered from increased complications compared to the rest of the HIV+ population studied. CD4 cells are a type of lymphocyte that helps fight viruses and other infections. Post-surgery complications can include such things as wound infections, longer lengths of stay in the hospital and bacterial infections.

In the current study, HIV+ patients were matched with HIV-negative patients by type of surgery, year the surgery took place, location of surgery, gender and age. The pairs had similar co-morbidities, lengths of stay in the hospital and number of surgical visits following their operations. More than two-thirds of the HIV+ patients had received HAART within 180 days prior to surgery and nearly 70 percent of the 332 had an AIDS diagnosis before undergoing a procedure.

"One of the things that prompted the current study was that previous research had conflicting results, showing both positive and negative outcomes," says Horberg. Also, he adds, "Pre-HAART-era research generally posited that surgical outcomes were worse, but these studies were often inconsistent, with small sample sizes."

The study was funded through the Kaiser Permanente Northern California Community Benefit Program. Additional Kaiser Permanente researchers on the study include Leo Hurley, MPH; Daniel B. Klein, MD; Stephen E. Follansbee, MD; Charles Quesenberry, PhD; Jason Flamm, MD; Gary Green, MD; and Tye Luu, RN.

The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 400-plus staff is working on more than 250 epidemiological and health services research projects.

For more information about Kaiser Permanente research, go to: http://blog.kaiser-permanente.org/research/ .

Kaiser Permanente

CONTACT: Maureen McInaney, +1-510-987-4779, or Maureen.McInaney@kp.org,or Michelle Ponte, +1-510-267-5354, or Michelle.Ponte@kp.org, or 24-hour mediahotline, +1-510-987-3900

Web site: http://www.kaiserpermanente.org/

Source: PRNewswire

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