OVERVIEW
Acquired Immunodeficiency Virus (HIV) surgical infections are infections associated with carriers of the acquired immunodeficiency virus (HIV), patients with the disease who need to undergo surgical procedures, or those that occur postoperatively.The HIV virus is characterized by attacking the body’s CD4+ T-cells, leading to a severe impairment of the body’s immune function, and ultimately complicating a variety of serious infections and tumors.
Etiology
HIV-induced immunodeficiency and malnutrition are the main causes of surgical infections.
Symptoms
Because of the severe deficiency of the body’s immune function, the clinical manifestations are multi-systematic changes and are not specific. There can be an incubation period of nearly 10 years from the onset of infection to the appearance of obvious clinical manifestations, so there is no obvious discomfort in the early stages of HIV infection. After the onset of the disease, there may be fever, pharyngitis, enlarged lymph nodes, headache, arthralgia, anorexia, nausea, vomiting, weight loss, skin rash and peripheral neuropathy. According to the effects of HIV on different organs, the manifestations of HIV surgical infection can be summarized as follows.
1. Anorectum
Common diseases include rectal ulcer, anal fistula, perianal abscess, which manifests as severe anal pain, ulceration and bleeding.
2.Colon
Common diseases include colitis, which manifests as lower abdominal pain with fever, and in severe cases, bloody mucus stools can occur. Toxic megacolon as well as intestinal perforation can be life-threatening.
3. Appendix
Appendiceal perforation is highly prevalent in HIV patients and manifests as chronic abdominal pain that worsens progressively, accompanied by diarrhea.
4. Esophagus
Esophageal ulcers are present in most HIV-infected patients, manifesting as dysphagia and retrosternal discomfort, and in severe cases, esophageal perforation.
5. Stomach and small intestine
Common diseases include gastritis, gastroduodenal ulcer, manifested by abdominal pain, diarrhea and gastrointestinal bleeding.
6. Liver, biliary and pancreatic system
Common diseases include stone cholecystitis, hepatitis, acute pancreatitis, manifested by abdominal pain, jaundice and abnormal liver function.
Examination
1. HIV1/2 antibody and antigen test
HIV1/2 antibody and antigen tests include screening tests (including initial screening and retesting) and confirmatory tests. HIV1/2 antibody screening methods include ELISA, chemiluminescence or immunofluorescence tests, rapid tests (spot ELISA and spot immunocolloidal gold or colloidal selenium rapid test, gelatin particle agglutination test, immunochromatographic test), etc., and immunoblotting is the commonly used method in confirmatory tests.
2. Determination of viral load
Commonly used methods include reverse transcription PCR (RT-PCR), nucleic acid sequence-dependent amplification (NASBA?Nuclisens), branched DNA signal amplification system (bDNA) and real-time fluorescence quantitative PCR amplification (realtime PCR). The clinical significance of viral load measurement includes predicting disease progression, providing a basis for initiating antiretroviral therapy, evaluating treatment efficacy, guiding the adjustment of treatment regimens, and serving as a reference indicator for the early diagnosis of HIV infection.
3.CD4+ T-lymphocyte assay
After HIV infection, there is a progressive reduction of CD4+ T lymphocytes, inverted CD4+/CD8+ T cell ratio and impaired cellular immunity. If HAART is performed, CD4+ T-lymphocytes may increase to different degrees at different stages of the disease.
4. HIV genotypic drug resistance assays
There are genotypic and phenotypic methods for drug resistance determination, and genotypic testing is currently used both domestically and internationally. It is recommended to conduct HIV genotypic drug resistance test in the following cases: when the viral load reduction of antiretroviral therapy is not satisfactory or when antiretroviral therapy fails and requires a change of treatment regimen; if conditions permit, it is better to conduct drug resistance test before antiretroviral therapy in order to choose the appropriate antiretroviral drug and obtain the best antiretroviral effect.
5. Other
Blood routine shows decreased lymphocytes, decreased platelet count, decreased red blood cell count, and so on.
Diagnosis
HIV infection can be clearly diagnosed by serologic testing, but other opportunistic infections caused by HIV infection after infection and before the onset of disease are difficult to diagnose. In addition to clear clinical manifestations, pathogenetic tests are also needed to supplement the diagnosis.
Treatment
HIV patients with concomitant surgical infectious disease require appropriate surgical management, and surgical risk assessment should take into account three factors: CD4+ T-lymphocyte count, blood HIV load, and the ability to receive antiretroviral therapy. Patients have a high rate of surgical complications and mortality due to severe immunodeficiency, such as incision infection and delayed incision healing. For HIV-positive patients who must undergo surgery, they need to receive concomitant antiretroviral therapy, enhanced nutritional and immune support, prophylactic perioperative antibiotics, strict asepsis, and avoidance of endotracheal intubation and indwelling urinary catheterization to minimize the incidence of infection.