Surgery in HIV-positive and AIDS patients: indications and outcome

We have reviewed the indications for and outcome of surgery in 147 patients who were seropositive for human immunodeficiency virus (HIV), 100 of whom have developed acquired immunodeficiency syndrome (AIDS). There were 256 operations; the commonest indications were anorectal conditions (34%), central venous access (21%), lymph node and soft tissue biopsy (15%) and an important minority underwent laparotomy (4%). Complications occurred in 20% of operations and repeat procedures were required in 35 patients. Both were of equal frequency in the HIV and AIDS populations. Most operations were therefore minor, and achieved satisfactory results with an acceptable morbidity. The possibility of HIV-related infection or malignancy affected the diagnostic and therapeutic approach, particularly in those considered for anorectal surgery or laparotomy. With increasing numbers of HIV-infected patients, knowledge of the types of surgery required and the likely outcome is important to enable provision of a safe and effective surgical service.