HIV, appendectomy and postoperative complications at a reference hospital in Northwest Tanzania: cross-sectional study

Abstract

BackgroundAppendicitis is a frequent surgical emergency worldwide. The present study was conducted to determine the prevalence of HIV, and the association of infection with clinical, intraoperative and histological findings and outcome, among patients with appendicitis.MethodsWe performed a cross sectional study at Weill-Bugando Medical Centre in northwest Tanzania. In total, 199 patients undergoing appendectomy were included. Demographic characteristics of patients, clinical features, laboratory, intraoperative and histopathological findings, and HIV serostatus were recorded.ResultsIn total, 26/199 (13.1%) were HIV-seropositive. The HIV-positive population was significantly older (mean age: 38.4 years) than the HIV-negative population (25.3 years; p < 0.001). Leukocytosis was present in 87% of seronegative patients, as compared to 34% in seropositive patients (p = 0.0001), and peritonitis was significantly more frequent among HIV-positives (31% vs. 2%; p < 0.001). The mean (SD) length of hospital stay was significantly longer in HIV-positives (7.12 ± 2.94 days vs. 4.02 ± 1.14 days; p < 0.001); 11.5% of HIV patients developed surgical site infections, as compared to 0.6% in the HIV-negative group (p = 0.004).ConclusionHIV infections are common among patients with appendicitis in Tanzania, and are associated with severe morbidity, postoperative complications and longer hospital stays. Early diagnosis of appendicitis and prompt appendectomy are crucial in areas with high prevalence of HIV infection. Routine pre-test counseling and HIV screening for appendicitis patients is recommended to detect early cases who may benefit from HAART.

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

“…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). These results support the theory that HIV status may be a risk factor for appendicitis (11,12).…”

“…In a prospective cohort study, ČaČala et al (16) showed that HIV status did not influence the outcome of general surgical procedures, and CD4+ count was not a prognosticator of total hospital stay, hospital mortality and severity of post-operative sepsis. However, in a recent large retrospective study investigating the effects of HIV status on the outcomes of surgical sepsis, Green et al (6) determined that there was a significantly higher mortality of 60% in patients who had a CD4+ count <200 cells/μl versus 2% in the CD4+ count >200 cells/μl group. In emergency surgery patients, a lower CD4+ count is associated with increased post-operative septic complications and longer hospital stay (14,15,17,19).…”

“…Failure to mount an immune response can manifest clinically by the absence of pyrexia and abdominal signs in early appendicitis. Localised right iliac fossa tenderness is not common in those infected with the virus (4) and pre-operative leukocytosis is also less frequently observed (6). Many have suggested that the absence of these clinical signs, symptoms and laboratory findings contribute to the delay in hospital presentation, and the subsequent higher morbidity.…”

“…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.…”