Surgery and human immunodeficiency virus disease

People with human immunodeficiency virus disease (HIVD) frequently present to surgical services for consideration of surgical therapies. They may be counseled by physicians who introduce into the decision-making process their personal fear of contagion, uncertainty about potential therapeutic benefits of surgery for people with HIVD, and anecdotal impressions that the immunodeficiency of HIVD might be accelerated by surgical and anesthetic interventions. However, there are no studies that have investigated immunomodulating effects of surgery and anesthesia in people with HIVD. Also, clinical studies of surgical interventions in populations of people with HIVD do not clearly demonstrate adverse outcomes attributable to surgery alone. Review of immunomodulating effects of surgical procedures in populations of people without HIVD reveals that multiple alterations of immune parameters may occur in response to all phases of anesthesia, surgery, and postoperative recovery. These alterations often depend upon the type of anesthesia used and the degree of surgical trauma. Most notably, the alterations are transient and rarely correlated with adverse clinical outcomes. These facts mitigate against the current preconceived notion that surgery will superimpose a sustained and clinically significant detriment to the immunologic competence of people with HIVD. A proposal for rational exploration and study of this issue is presented.