ABSTRACT Objective: To investigate the relationship between immune function and perioperative sepsis in HIV-positive patients. Methods: Retrospective analysis of 144 HIV-positive patients surgically treated from Oct 2008 to Dec 2010 in Shanghai Public Health Clinical Center. The patients were divided into four groups based on their CD4+ T cells counts in preoperative period: group A (0 – 99 cell/ul), group B (100 – 199 cell/ul)，group C (200 – 349 cell/ul)，group D (≥350 cell/ul). All patients had received standardized surgical procedures, careful surgical routines were applied. To reduce operational damage, conventional antibi-otics, anti-TB, anti-fugal, antiretroviral therapies were used to prevent infection and promptly treatment of complications. Results among 144 HIV-positive patients (male 133 and female 11, aged 42.6 ± 12.5), 80 patients got perioperative sepsis (14 cases in preoperative period and 66 cases in postoperative period). 64 cases did not get sepsis. The average CD4+ T cell count was 276.97 ± 137.91 in preoperative period of patients without sepsis, which was significant higher than the patients with preoperative sepsis (151.29 ± 110.64) and patients with postope- rative sepsis(161.14 ± 128.45) (F = 13.91, P < 0.05). There were statistic differences of perioperative sepsis among A group (82.6%), B group (69.8%), C group (40.5%) and D group (26.9%) (χ2 = 23.680, P < 0.01). Three cases died of MODS in group A , each one died of MODS in group B and group C. There was no death in group D. There was negative correlation between the incidence of sepsis and levels of CD4+T cells (r = –0.987, P = 0.013). Conclusions With the decrease of preoperative CD4+T cells, the risk of perioperative sepsis had notable increase. Complete evaluation of surgical risk and suitable perioperative treatments may obtain better effect for the patients infected HIV.
Cite this paper
Liu, B. , Wang, M. , Su, J. , Song, Y. , Liu, L. and Li, L. (2012) Correlation analysis of compromised immune function with perioperative sepsis in HIV-positive patient. Health, 4, 190-195. doi: 10.4236/health.2012.44028.
 Moore, C.C., Jacob, S.T., Pinkerton, R., et al. (2008) Point-of-care lactate testing predicts mortality of severe sepsis in a predominantly HIV type 1—Infected patient popula-tion in Uganda. Clinical Infectious Diseases, 46, 215-222. doi:10.1086/524665
Zaidi, A.K., Ganatra, H.A., Syed, S., et al. (2011) Effect of case management on neonatal mortality due to sepsis and pneumonia. BMC Public Health, 11, 13. doi:10.1186/1471-2458-11-S3-S13
Levinson, A.T., Casserly, B.P. and Levy, M.M. (2011) Reducing mortality in severe sepsis and septic shock. Seminars in Respiratory and Critical Care Medicine, 32, 195- 205. doi:10.1055/s-0031-1275532
Lagu, T., Rothberg, M.B., Nathanson, B.H., et al. (2011) The relationship between hospital spending and mortality in patients with sepsis. Archives of Internal Medicine, 171, 292-299. doi:10.1001/archinternmed.2011.12
Levy, M.M., Fink, M.P., Marshall, J.C., et al. (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Critical Care Medicine, 31, 1250-1256. doi:10.1097/01.CCM.0000050454.01978.3B
Jeremiah, L. Deneve, D.O., Jessica, G., et al. (2010) CD4 count is predictive of outcome in HIV-positive patients undergoing abdominal operations. American Journal of Surgery, 200, 694-700. doi:10.1016/j.amjsurg.2010.07.030
Pereyra, F., Palmer, S., Miura, T., et al. (2009) Persistent low-level viremia in HIV-1 elite controllers and relationship to immunologic parameters. Journal of Infectious Diseases, 200, 984-990. doi:10.1086/605446
Jain, S.B., Wig, N., Nagpal, S.J., et al. (2011) Evaluation of the current management protocols for prophylaxis against Pneumocystis jiroveci pneumonia and other opportunistic infections in patients living with HIV/AIDS. AIDS Care, 23, 1-5. doi:10.1080/09540121.2010.542129
Sax, P.E., Sloan, C.E., Schackman, B.R., et al. (2010) Early antiretroviral therapy for patients with acute aidsrelated opportunistic infections: A cost-effectiveness analysis of ACTG A5164. HIV Clinical Trials, 11, 248-259. doi:10.1310/hct1105-248
Kulkarni, S.V., Kairon, R., Sane, S.S., et al. (2009) Opportunistic parasitic infections in HIV/AIDS patients presenting with diarrhoea by the level of immunesuppression. Indian Journal of Medical Research, 130, 63-66.
Hocqueloux, L., Prazuck, T., Avettand-Fenoel, V., et al. (2010) Long-term immunovirologic control following antiretroviral therapy interruption in patients treated at the time of primary HIV-1 infection. AIDS, 24, 1598-1601. doi:10.1097/QAD.0b013e32833b61ba
Lemma, M., Vanelli, P., Beretta, L., et al. (1992) Cardiac surgery in HIV-positive intravenous drug addicts: Influence of cardiopulmonary bypass on the progression to AIDS. Journal of Thoracic and Cardiovascular Surgery, 40, 279- 282. doi:10.1055/s-2007-1022720
Fasan, M.L., Morandi, E., Fociani, P., et al. (2003) AIDS-associated gastrointestinal lymphoma: Is there a role for surgery in the standard of care? Journal of Acquired Immune Deficiency Syndromes, 34, 345-347. doi:10.1097/00126334-200311010-00015