[HIV/AIDS positive patients in surgery. Part I: Epidemiologic situation]

The paper is mostly based on materials and experience of the first author, who took part in an expert action, together with an international team of surgeons, treated more than 6000 HIV-positive patients in Botswana and performed more than 3,200 interventions himself. The co-authors corrected the African experience by a brief survey of experience in this country and reviewed the presently valid legislation.

The first two parts deal with literature knowledge on HIV/AIDS and confront it with the author's experience over three years of his expert stay in a hospital in Gabarone. The first part deal with epidemiological situation in the place of study and the second part analyzes in a general aspect the problems of surgical intervention in HIV-positive patients and the occupational risk. This part also includes a corresponding description of conditions in the Czech Republic including Czech legislation. The third, principal, part of the contribution is a prospective study where the author, under limited local conditions, investigated 3,200 HIV-positive patients undergoing surgery. The relation between HIC and tuberculosis is also analyzed from various other minor aspects and there are mainly the levels of CD4+ T lymphocytes followed from the standpoint of course of therapy and prognosis of the patients. The fourth part of the paper describes briefly twelve cases confirming and illustrating the results.

HIC-positive individuals with the CD4 value below 200/mm3 represent the critically endangered patients. The values between 200 and 499 represent a distinct risk, which may be overcome, and values between 500 and 799 represent a minimum risk, whereas the value over 800 is exceptionally favorable. Tuberculosis is a very frequent opportune infection in African conditions (over 53% in the cohort under study), but rather than to influence the prognosis itself it act in relation to the values of CD4+ T lymphocytes. The main risk for surgical patients related to decreased immunity is not due to complications in the wounds and anastomoses, but in severe opportune infections.

This most comprehensive surgical survey on HIV/AIDS, worked out by Czech authors, is very well applicable in conditions of the Czech Republic.