HIV infections pose many immediate risks to its sufferers, especially those undergoing even the most simple of surgeries. Recent research in the European Journal of Anesthesiology has found that patients with HIV have five times a greater risk of post-operative mortality within the 30-day period after surgery. As grave a statistic as this is, things may be looking up as research is beginning to suggest those treated with antiretroviral therapy (ART) may have a more positive post-surgical outcome. A new study, published online in JAMA Surgery, suggests mortality rates after operations have decreased in patients receiving ART, but as of now direct causation is still under scrutiny. ART is also responsible for making HIV a chronic disease, and thus patients are now able to undergo a variety of surgeries.

Dr. Joseph T. King of the Veterans Affairs Connecticut Healthcare System and his team of researchers initiated this study by analyzing U.S. Veterans Health Administration Healthcare System’s electronic medical records from 1996 to 2010 to compare 30-day post-operative mortality trends in patients with HIV receiving ART. Records on 1,641 post-surgical HIV patients were compared with 3,282 uninfected patients not undergoing ART, but who had undergone the same surgical procedure.

The most common procedures for both groups within the study consisted of cholecystectomy, or gall bladder removal at 10.5 percent; hip arthroplasty, or hip replacement at 10.5 percent; spine surgery at 9.8 percent; herniorrhaphy, or hernia repair at 7.4 percent; and coronary artery bypass grafting at seven percent. In the patients with HIV, a wide range of CD4 cell counts, an indicator of immune system function, were tested to see how CD4 cell count affected post-operative mortality. Out of this test group, 80 percent had a CD4 cell count at 200/μL or more, 16.3 percent fell within the range of 50/μL to 199/μL and 3.7 percent had less than 50/μL.; 74.1 percent had undetectable levels of HIV-1 RNA (viral suppression).

The results showed that patients with HIV had a post-operative mortality rate of 3.4 percent, or 56 patients, within the 30-day period, compared to 1.6 percent (53 patients) in the uninfected group. “HIV-infected individuals with a CD4 cell count higher than 200/μL can be expected to have a post-operative mortality rate similar to that in an uninfected individual 16 years older,” say authors of the study. “Surgery on a 50-year-old patient with HIV infection who is receiving ART has a 30-day mortality risk similar to that of a 66-year-old individual without the infection.”

The study also found that poor nutritional status (hypoalbuminemia) and age contribute to mortality rates within patients. As a result, authors caution that this must be considered when reviewing the outcome of the study. “Many uninfected patients have post-operative risks that exceed those of HIV-infected patients with CD4 cell counts above 200/μL. For example, a 45-year-old HIV-infected patient with a CD4 cell count of 200/μL or more had a lower rate of 30-day postoperative mortality than did any 65-year-old uninfected patient or a 45-year-old uninfected patient with hypoalbuminemia,” note authors. Because of this, authors suggest that HIV-infection and CD4 cell counts not be the only factor taken into account when assessing a patient’s likelihood of mortality after surgery.

Even though the study cannot fully prove that ART is contributing to decreased mortality rates in post-op HIV-infected patients, it still proves a step in the right direction for treating this debilitating disease.

Source: King J, Postoperative Mortality Rates Low Among Patients with HIV Prescribed ART. JAMA Surgery. 2015.