HIV Infection: Its Impact on Patients with Appendicitis in Botswana

Abstract

Background To compare the presentation, management, and outcome of HIV-positive patients with appendicitis to those of HIV-negative patients with appendicitis. Summary Background Data: The literature is limited regarding the impact of HIV infection on patients with appendicitis. Methods A retrospective review of patients with appendicitis and known HIV status admitted to Princess Marina Hospital, Gaborone, Botswana, aged 13 years and greater was performed from January 2013 to December 2015. Data on patient demographics, presentation, laboratory findings, management, and outcomes were analyzed. Results A total of 295 patients with appendicitis and known HIV status were identified, of which 119 (40.3%) were HIV positive. The median [IQR] ages for HIV-positive and HIV-negative patients were 34 [29][30][31][32][33][34][35][36][37][38][39][40][41][42] and 26 [20][21][22][23][24][25][26][27][28][29][30][31][32][33] years, respectively. The male-to-female ratio for the same two groups was 0.8:1 and 1.4:1, respectively. Presenting symptoms, signs, and white blood cell count were similar in both groups. HIV-positive patients had significantly higher overall (4.2 vs. 0.0%, p = 0.010) and postoperative (4.4 vs. 0.0%, p = 0.024) mortality rates. There was no significant difference in the total complication rate between HIV-positive and HIV-negative patients (13.2 vs. 7.9%, p = 0.192). Compared to HIV-positive patients with a CD4 count C200, patients with a CD4 count \200 have a significantly higher postoperative mortality rate (17.6 vs. 1.4%, p = 0.023) and a trend toward a higher total postoperative complication rate (31.3 vs. 10.8%, p = 0.054). Conclusion Within our setting, HIV infection, particularly with a CD4\200, was correlated with significantly higher mortality in patients with acute appendicitis.

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

“…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. León-Ballesteros et al…”

“…This syndrome is associated with initiation of combined antiretroviral therapy (cART), which initiates a pathological inflammatory response to a previous infection resulting in appendicitis. 10,11 Different mechanisms were also suggested to have role in the AA such as strong interferon response in the appendix may in part endorse a viral aetiology for the inflammation. 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.…”

“…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.…”

“…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. León-Ballesteros et al showed that AA in PLWHIV can be associated with low prevalence of leukocytosis; however, their study showed that presence of both diabetes and HIV can be associated with high rate of surgical complications and an increase in hospital stay.…”

“…Perioperative care is essential and attention should be paid to the fact that these patients are at risk of developing complications like infection, delay in wound healing, perforation, intra-abdominal abscess, peritonitis and prolonged hospital stay, and ultimately all these complication may lead to an increase in mortality. 9 – 11…”