title: Effect of CD4+ T-lymphocyte count on hospital outcome of elective general thoracic surgery patients with human immunodeficiency virus.
abstract: OBJECTIVE
  Traditionally, the chief surgical indicator for human immunodeficiency virus (HIV)-infected patients was the CD4-positive T-lymphocyte count; however, there is no current consensus. Reports published after 2006 indicated that HIV-infected patients had a higher incidence of postoperative pneumonia and higher 12-month mortality rates. In addition, CD4 counts had no relation to the in-hospital outcome. Therefore, we retrospectively examined all of the previous patients who underwent operations in our department on the basis of these findings.
  
  
  METHODS
  Regardless of the initiation of highly active anti-retroviral therapy (HAART), we retrospectively reviewed 10 general thoracic surgeries performed in our department according to the CD4 cell count, HIV-ribonucleic acid (RNA) viral load, time of HAART initiation, operating time, amount of blood, postoperative course, and period of observation.
  
  
  RESULTS
  There was no incidence of postoperative pneumonia or wound infection. There were also no complications during the perioperative period. One patient died 7 months after surgery.
  
  
  CONCLUSIONS
  Our retrospective study demonstrates that the indicator for elective general thoracic surgery is not the CD4-positive T-lymphocyte count and that the initiation of HAART may reduce the 12-month mortality rates. In HIV-positive patients, regardless of the CD4-positive T-lymphocyte count, surgeons can operate in the same manner as they would with HIV-negative patients.
authors.affiliation: Department of Thoracic Surgery, National Centre for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. snagasak@hosp.ncgm.go.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagasaka
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Yazaki
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Oka
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kuwata
authors.forename: Ayako
authors.initials: A
authors.lastname: Seike
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Kitazawa
authors.forename: Shoji
authors.initials: S
authors.lastname: Fukuda
authors.forename: Shigeru
authors.initials: S
authors.lastname: Hosaka
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D005260:Female; D006678:HIV / Q000235:genetics / Q000276:immunology*; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality / Q000821:virology; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D015415:Biomarkers; D012367:RNA, Viral
references.citation: Arch Surg. 2006 Dec;141(12):1238-45
references.pmid: 17178967
references.citation: Acta Obstet Gynecol Scand. 1999 Oct;78(9):789-92
references.pmid: 10535342
references.citation: Mt Sinai J Med. 2002 Oct;69(5):329-33
references.pmid: 12415327
references.citation: World J Surg. 2009 May;33(5):899-909
references.pmid: 19280251
references.citation: Eur J Obstet Gynecol Reprod Biol. 2000 May;90(1):73-6
references.pmid: 10767514
references.citation: Am J Surg. 2000 Sep;180(3):228-33
references.pmid: 11084136
references.citation: Khirurgiia (Mosk). 2000;(7):46-50
references.pmid: 10958070
references.citation: Dig Surg. 1999;16(1):60-7
references.pmid: 9949269
references.citation: Ann R Coll Surg Engl. 2006 Jan;88(1):46-51
references.pmid: 16460640
references.citation: JAMA. 1993 Feb 10;269(6):729-30
references.pmid: 8093740