Appendicitis in the HIV Era: a South African perspective

Abstract

The relationship between HIV infection and the clinical spectrum of appendicitis has not been fully elucidated in the South African context. The aim of this study is to compare the surgical management, histopathology, and outcomes between HIV-positive and HIV-negative patients undergoing surgery for appendicitis. A retrospective chart analysis was performed of 50 patients who underwent surgery for appendicitis at King Edward VIII Hospital, Durban, South Africa between January 2012 and December 2012. Patients were stratified by HIV serostatus into HIV-positive and HIV-negative groups. Fifty patients underwent surgery for appendicitis during the study period. Of the 50 patients, 14 were HIV-positive (28 %) and 36 were HIV-negative (72 %). Perforated appendicitis was more frequent in the HIV-positive group (50 vs. 25 %, > 0.05). There was a significantly higher laparotomy rate in HIV-positive patients (71 vs. 33 %, < 0.05). Granulomatous inflammation of the appendix was only noted in HIV-positive patients ( = 3). There was no significant difference in the complication rate between the two groups () and no difference in the mean length of hospital stay (7.8 ± 4.89 vs. 5.8 ± 3.94 days, > 0.05). In this retrospective study, perforated appendicitis was seen to be more common in HIV-positive patients resulting in a higher laparotomy rate in this group. Granulomatous inflammation was only found in HIV-positive patients. There was no difference seen in the complication rate, length of hospital stay, and mortality between HIV-positive and HIV-negative patients.

A Study Comparing Outcomes of Appendectomy between HIV-Infected and HIV-Negative Patients

“…An HIV seroprevalence of 13.4% in this cohort of patients is not negligible and is comparable to data from other Sub-Saharan centres. Gigabhoy et al (4) recently showed that the HIV prevalence in patients undergoing appendectomy at a large tertiary urban hospital is 28%. In a Tanzanian study conducted at a major referral centre, the prevalence was found to be 13.1% (6).…”

“…The laparotomy rate was higher in HIV+ patients (72.2% vs. 41.3%, P=0.03). Previous authors have ascribed this operative approach to the high rate of perforation and peritonitis, that occurdue to the delay in presentation of these patients (4,6). The morbidity relates predominantly to Surgical Site Infections, and is reduced with a laparoscopic approach (7,8).…”

“…Opportunistic infections such as Tuberculosis (TB) and AIDS-related malignancies such as Kaposi's Sarcoma (KS) and lymphoma will frequently mimic the clinical presentation of appendicitis. Whilst an appendectomy will assist the surgeon in confirming the diagnoses and direct further therapy, the associated post-operative morbidity and mortality are concerning (1,(4)(5)(6)(7)(8)(9).…”

“…The effect of HIV infection on appendicitis and the surgical outcomes thereof have not been studied enough, there are only six published reports in the current literature. Paradoxically, only two of these publications are from Sub-Saharan Africa where HIV is highly prevalent (4,6). The studies addressing surgical outcomes of appendicitis in HIV+ and HIV-patients are summarised in Table 1.…”

Acute appendicitis in people living with HIV: What does the emergency surgeon needs to know?

“…Such observation can be also endorsed by the fact that the appendix is also part of the gut lymphoid tissues and this may further explain the involvement of the mucosal B and T cells and the replication of the HIV virus in the appendix. 10,11 The role of immune status and CD4 count is also linked with AA. For example, Bedada et al 11 showed that high postoperative complications and mortality in HIV patients with AA can be associated with a CD4 count <200.…”