Introduction
Antiretroviral medication has increased the need for surgical operations in individuals with human immunodeficiency virus (HIV) infections, including avascular necrosis, coronary heart disease, and HIV-associated lipodystrophy as side effects from highly active antiretroviral therapy (HAART). Increasingly, individuals with HIV require surgical procedures, notably in the fields of plastic, cardiothoracic, and orthopedic surgery. Making surgical decisions when a patient has an HIV infection might be difficult. HIV infection has an impact on life expectancy, nutritional health, and the differential diagnosis of surgical disease. According to some, HIV infection may potentially have an impact on postoperative wound healing and complication rates. Surgery on HIV-positive patients has been reported to produce either extremely poor or remarkably excellent results. This article will discuss the complications of the surgery.
What Is Human Immunodeficiency Virus (HIV) Infections?
HIV (human immunodeficiency virus) is a virus that attacks the immune system, which is responsible for fighting off infections and diseases in the body. The virus targets and destroys a type of white blood cell called CD4+ T cells, which play an essential function in the immune system. As HIV progressively destroys more CD4+ T cells, the immune system becomes weaker and less able to fight infections and diseases. HIV is primarily spread through contact with infected body fluids like blood, semen, vaginal secretions, and breast milk and can transmit infections or diseases through activities like sexual intercourse, sharing needles or injection tools, or from a mother to her child during pregnancy: childbirth, or breastfeeding. HIV can lead to a serious, chronic condition called AIDS (acquired immunodeficiency syndrome) if left untreated. At present, there is no known cure for HIV, but antiretroviral therapy (ART) can effectively suppress the virus and prevent the development of AIDS. Individuals with the virus can still maintain extended periods of good health and longevity through proper treatment and management.
What Are Surgical Complications in HIV Patients?
It is now obvious that surgical risk is significantly influenced by the diagnostic that calls for surgery and the urgency of the treatment. The risk of morbidity is increased three to four times, and the average mortality rises from 15 % to 45 % when an AIDS-related disease is the cause of emergency abdominal surgery. Currently, it is thought that the fact that many patients with HIV disease were in their latter stages of the disease, combined with an insufficient understanding of the illness and the time of surgery, contributed to the disappointing early outcomes of surgery in these individuals. Another element in estimating surgical risk is whether the procedure is emergency or elective: Emergency surgery has a greater death rate and more complications.
It is challenging to determine the precise risk of surgical procedures in people with HIV illness, and the findings of various retrospective investigations are inconsistent. For a variety of reasons, patients with HIV/AIDS are thought to pose a high risk for surgical complications.
The following are the reasons for the risk of poor surgical complications:
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Immune system deficiencies lead to poor wound healing.
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A higher perioperative complication rate is linked to surgery.
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The high mortality rate of these patients.
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The high mortality of these patients necessitates prolonged care. Healthcare staff are unnecessarily exposed to the virus.
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Insufficient understanding of the illness and the time of surgery.
HIV-positive individuals who undergo surgical procedures may be at an increased risk of certain surgical complications due to their weakened immune system and other HIV-related factors. Some of the potential surgical complications in HIV patients include:
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Increased Risk of Infections: HIV patients have a weakened immune system, making them more susceptible to infections. This makes them more vulnerable to postoperative infections.
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Delayed Wound Healing: HIV can impair the healing of surgical wounds and incisions, leading to prolonged healing times.
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Bleeding: HIV patients may have a low platelet count, leading to increased bleeding during and after surgery.
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Anemia: HIV-positive individuals may have anemia, which can be exacerbated by surgical procedures and blood loss during surgery.
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Adverse Drug Reactions: HIV-positive individuals may be taking a combination of antiretroviral medications, which can interact with other drugs used during surgery and cause adverse reactions.
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Compromised Respiratory Function: HIV patients may have lung disease or compromised respiratory function, which can lead to complications during anesthesia and postoperative care.
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Compromised Liver Function: HIV patients may have liver disease or compromised liver function, which can impact the processing of medications and anesthesia during surgery.
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Anesthetic Risk For HIV-Infected Patients - The risks associated with anesthesia and surgery for HIV-positive patients are poorly understood. Pneumocystis carinii pneumonitis (PCP), aspergillosis, Herpes infections, candidiasis, and CMV pneumonitis are all respiratory illnesses linked to HIV. Kaposi's sarcoma, lymphoma, and cavitating lung disease are further respiratory problems.
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Cardiovascular Complications - Potential cardiovascular complications include congestive cardiac failure secondary to ischemic heart disease and, more rarely, as a consequence of bacterial endocarditis, particularly with intravenous drug users (IVDUs). HIV and other opportunistic infections may cause myocarditis, progressing to dilated cardiomyopathy.
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Gastrointestinal Complications - Complications of the gastrointestinal system associated with HIV and its treatment include diarrhea, vomiting, and loss of appetite. Electrolyte imbalance may occur and require correction preoperatively. Liver dysfunction should be explored as viral hepatitis may coexist.
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Nervous-System Complications - Toxoplasmosis, subacute encephalitis, meningitis, Herpes simplex encephalitis, polyneuropathy, and HIV-related dementia are complications of the nervous system that occur frequently in HIV.
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HIV-Associated Lipodystrophy - HIV-associated lipodystrophy is a syndrome of fat redistribution and metabolic alterations associated with the use of highly-acting antiretroviral therapy (HAART). The metabolic effects include peripheral and hepatic insulin resistance, impaired glucose intolerance, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, and increased free fatty acids.
How to Prevent Surgical Complications in HIV Patients?
Careful diagnosis can prevent complications in HIV patients. It is difficult to say exact methods to prevent complications, but few can help to get an accurate diagnosis.
The following are the ways to prevent a few complications:
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Patients should be properly evaluated prior to surgery.
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A preoperative ECG and echocardiogram (transthoracic or transesophageal) are useful for identifying cardiac abnormalities and can prevent cardiovascular complications.
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Liver dysfunction should be explored as viral hepatitis may coexist to prevent gastrointestinal complications.
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Oxygenation should be maintained postoperatively, particularly in patients with HIV lipodystrophy at increased risk of cardiovascular complications.
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Patients receiving prophylactic treatment for AIDS-related infection or neoplasm have been shown to have better survival rates.
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To help patients recover from an invasive treatment, they need strong nutritional assistance.
Conclusion
Early diagnosis and therapy are advantageous for surgical disease patients in general. In immunocompromised individuals, a delay in diagnosis may reflect subtler clinical symptoms, yet early management is linked to enhanced survival compared to emergency operations. Prior to surgery, patients should be properly evaluated, and risk-reduction strategies should be used to safeguard both the patient and the healthcare professionals.
