title: Pre-operative clinical assessment for anaesthesia and the effect of HIV infection.
abstract: BACKGROUND
  HIV infection is common in South Africa, often remaining clinically latent and liable to be missed during clinical pre-operative assessment, despite the patient having a severe degree of immune compromise.
  
  
  OBJECTIVE
  The primary objective was to determine the pre-operative physical status of patients presenting for anaesthesia, and to compare this with subsequent HIV tests and the CD4 counts of the HIV-positive patients. The secondary objective was to determine the prevalence of HIV infection in this group and in selected subgroups.
  
  
  METHODS
  A sample of 350 adult patients presenting for anaesthesia at Chris Hani Baragwanath Hospital were interviewed pre-operatively, examined, and their American Society of Anesthesiologists physical status grading determined. In those who were confirmed HIV positive by blood sample, a CD4 count was checked. Further data were collected to determine trends in the characteristics of HIV-positive patients.
  
  
  RESULTS
  HIV-positive patients were more likely to be classified as ASA 1 or 2 than ASA 3 or 4 (odds ratio (OR) 2.1). HIV-positive patients with CD4 counts >200 cells/microl were more likely to be ASA 1 or 2 (OR 3.88). Of HIV-positive patients with CD4 counts <200 cells/microl, significantly more were classified as ASA 1 or 2 than ASA 3 or 4 (p < 0.0001). Three patients with CD4 counts <50 cells/microl were classified as ASA 1 or 2. The overall prevalence of HIV infection was 29.4%. Females, patients presenting for obstetric surgery, and younger age groups had higher disease prevalence rates. Patients aged 30 - 39 years (43.0%) had the highest prevalence of HIV infection; the lowest was in patients aged 60 years or older (7.7%).
  
  
  CONCLUSIONS
  Routine clinical pre-operative assessment in patients from a population with a high HIV prevalence rate may result in asymptomatic, severe immune compromise being missed in a significant number of patients.
authors.affiliation: Department of Anaesthesia, Chris Hani Baragwanath Hospital, Soweto, Johannesburg. prpenfold@mweb.co.za
authors.forename: P R
authors.initials: PR
authors.lastname: Penfold
authors.forename: A C
authors.initials: AC
authors.lastname: Lundgren
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000503:physiopathology*; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011300:Preoperative Care; D015995:Prevalence; D013019:South Africa / Q000453:epidemiology