Impact of highly active antiretroviral therapy on outcome of cholecystectomy in patients with human immunodeficiency virus infection.
BACKGROUND
Highly active antiretroviral therapy (HAART) reduces virus proliferation and significantly decreases the rate of septic and opportunistic complications in patients infected with human immunodeficiency virus (HIV). Although surgery is performed routinely on patients receiving HAART, the effect of this treatment on surgical outcome has not been examined in detail.


METHODS
This retrospective study reviewed 54 consecutive patients with HIV infection who underwent surgical cholecystectomy: 31 patients were on HAART, 13 on nucleoside analogue reverse transcriptase inhibitors (NRTIs) and ten were receiving no specific therapy. Characteristics of HIV-1 infection, laboratory investigations, characteristics of the gallbladder disease, type of operation, postoperative course, morbidity and mortality were recorded. Univariable analysis and unconditional logistic regression were performed to determine factors related to postoperative complications and death.


RESULTS
The three groups were similar in terms of HIV-1 infection characteristics. In univariable analysis HAART and laparoscopic cholecystectomy were associated with a significantly lower complication rate, whereas only HAART was shown to be protective by logistic regression analysis. A low HIV RNA load and a high CD4(+) cell count were significant predictors of uncomplicated surgical outcomes.


CONCLUSIONS
HAART significantly reduces the risk of complications after cholecystectomy in patients with HIV infection or acquired immune deficiency syndrome.
Foschi
D
D
Department of S. Siro Clinical Institute, University of Milan, Milan, Italy. Diego.Foschi@unimi.it
Cellerino
P
P
Corsi
F
F
Casali
A
A
Rizzi
A
A
Righi
I
I
Trabucchi
E
E
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000821:virology*; D012189:Retrospective Studies; D016896:Treatment Outcome