With the introduction of highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV) infection has become a more chronic disease with improved survival. Thoracic surgeons are increasingly involved in surgical procedures in this patient population. Surgical indications and outcomes are important variables in treating these patients.
A retrospective review of patients operated on at three institutions over a 3-year period (2002 - 2004) was performed.
21 patients with HIV underwent surgery during this time period. A total of 22 procedures were performed. There were 13 males and 8 females. Age ranged from 15 - 64 years. Patients with known HIV infection prior to hospital admission numbered 18/21. Eleven patients had previously been diagnosed with AIDS. 11/21 patients were using HAART prior to admission. CD4 counts ranged from 1 - 1079 /ul. Indications for surgery included respiratory failure of uncertain etiology in 6/21 undergoing lung biopsies, empyemas in 4/21 undergoing decortications, mediastinal adenopathy in 2/21 undergoing VATS biopsy or mediastinoscopy, bronchopleural fistula in 2/21 undergoing lung resection, pleural tents and muscle flaps, pericardial tamponade in 2/21 undergoing VATS pericardial windows, vertebral collapse in 1/21 undergoing a thoracoabdominal approach for corpectomy and stabilization, rib lesions in 1/21 undergoing bilateral rib biopsies, undiagnosed pleural effusion in 1/21 undergoing diagnostic VATS and pleurodesis, fibrothorax with restrictive lung disease in 1/21 undergoing decortication and pleurectomy and esophageal cancer in 1/21 undergoing Ivor Lewis esophagectomy and later a tracheostomy. 4/21 patients died and the remaining were discharged home (15/17) or to a rehabilitation unit (2/17). All four patients who died had initially undergone non-diagnostic bronchoscopies followed by surgical lung biopsies. There were no needle stick injuries.
Despite the presence of HIV disease, thoracic surgical procedures appear safe in a select group of patients. Diagnostic lung biopsies for repiratory failure have an inherent poor outcome and this continues to be reflected in patients with underlying HIV disease.
Thoracic surgery can be performed with adequate results in patients with HIV and AIDS.
M. Margolis, None.