title: Is impaired immunity a consequence of surgery in patients infected by the human immunodeficiency virus?
abstract: BACKGROUND
  Surgery affects immune function adversely in a variety of clinical settings. To date, there are no data assessing immune function in patients infected with the human immunodeficiency virus (HIV) who have had surgery.
  
  
  METHODS
  A retrospective review was performed of 67 patients, of whom 46% were female, who underwent surgery while being treated for HIV infection. These patients were identified from a database collected over a ten-year period. The CD4(+) cell counts were analyzed according to the degree of immunosuppression (> or =500, 200-499, and <200 cells/mm(3), respectively). Viral titers also were assessed.
  
  
  RESULTS
  Of the 17 patients with CD4(+) cell counts >500/mm(3) prior to surgery, 64.7% had unchanged counts after surgery (95% confidence interval [CI] 32.9%, 81.6%), whereas 35.2% of patients had lower CD4(+) counts after surgery (95% CI 14.2%, 61.7%). In patients with preoperative CD4(+) counts between 200 and 500/mm(3), 9.7% (95% CI 2.0%, 25.8%) had their counts decrease to <200 cells/mm(3), whereas in 29% (95% CI 14.2%, 48.0%) of patients, the counts increased to within the normal range. In the most immunosuppressed group (CD4(+) counts <200/mm(3)), 15.8% of patients (95% CI 3.4%, 39.6%) had their CD4(+) counts increase to the intermediate range. In the majority of patients, the viral titers remained unchanged, whereas 18.8% (n = 6) (95% CI 7.2%, 36.4%) had a decline in their titers.
  
  
  CONCLUSIONS
  Surgery does not affect immune function adversely in HIV-infected patients, as judged by CD4(+) cell counts or viral titers.
authors.affiliation: Department of Surgery, Jersey Shore University Medical Center, Robert Wood Johnson Medical School, Neptune, New Jersey 07753, USA.
authors.forename: William
authors.initials: W
authors.lastname: Rahal
authors.forename: Jill
authors.initials: J
authors.lastname: Debari
authors.forename: Yen-Hong
authors.initials: YH
authors.lastname: Kuo
authors.forename: Kathleen
authors.initials: K
authors.lastname: Casey
authors.forename: John Mihran
authors.initials: JM
authors.lastname: Davis
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D019562:Viral Load