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Vascular disease in HIV/AIDS patients
J van Marle1, L Tudhope, G Weir
1Unit for Peripheral Vascular Surgery, Pretoria Academic Hospital, University of Pretoria.
Objectives:
An ongoing prospective clinical survey to determine the spectrum of vascular disease in HIV/AIDS patients and the risk factors affecting clinical outcome in order to formulate a management protocol for future use.
Methods:
Comprehensive screening for risk factors for vascular disease as well as HIV/AIDS-related conditions. Disease pattern and presentation are noted and patients treated accordingly. Vascular emergencies are managed regardless of HIV status because this information is usually not available at the time of presentation. Elective management is based on immune status and risk stratification.
Results:
42 patients tested positive for HIV. The majority of patients presented with occlusive disease (57%), followed by aneurysms (21%) and vascular trauma (19%). A variety of vascular surgical procedures were performed on 36 patients. There was no surgical mortality and 10 patients developed complications, including 2 amputations and 7 cases of minor wound sepsis. The 3 patients who received preoperative antiretroviral therapy showed a marked reduction in viral count and a significant improvement in CD4 T-cell count.
Conclusion:
Surgery can be safe and effective in HIV-positive patients provided the necessary precautions are taken to reduce surgical morbidity.