Preoperative clinical status in HIV-positive patients presenting for anaesthesia, and the correlation with the CD4-count
Date
2009-11-11T13:37:39Z
Authors
Penfold, Phillipa Rae
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Abstract
BACKGROUND
HIV infection is common in South Africa. The disease often remains clinically
latent, despite the patient having severe immune compromise. Clinical
preoperative assessment may result in patients with this severe systemic disease
going unnoticed.
OBJECTIVES
The primary objective was to determine the relationship between the preoperative
physical status of HIV-positive patients presenting for anaesthesia and the CD4-
count. The secondary objectives were to determine the prevalence of HIV
infection in this group of patients, to determine the prevalence of HIV infection in
selected subgroups, to ascertain what proportion of patients presenting for
anaesthesia know their HIV status, and to ascertain what proportion of HIVpositive
patients are receiving highly active antiretroviral therapy (HAART).
METHOD
A sample of 350 adult patients presenting for anaesthesia at Chris Hani
Baragwanath Hospital was selected. Patients were interviewed preoperatively
and were examined, and in doing so their ASA physical status grading was
determined. Blood was sampled, and in those who were confirmed HIV-positive,
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a CD4-count was checked. Further data were collected: age, gender, the type,
nature, urgency and time of day of surgery, the patient’s knowledge of their HIV
status, and whether the patient was receiving HAART or not.
RESULTS
HIV-positive patients were more likely to be classified as ASA 1 or 2 than ASA 3
or 4 (OR 2.1). HIV-positive patients with CD4-counts above 200 cells.mm-3 were
also more likely to be ASA 1 or 2 than ASA 3 or 4 (OR 3.88). However, within the
group of HIV-positive patients with CD4-counts below 200 cells.mm-3, significantly
more patients were classified as ASA 1 or 2 than ASA 3 or 4 (p<0.0001). Three
patients with CD4-counts below 50 cells.mm-3 were classified as ASA 1 or 2. The
overall prevalence of HIV infection was 29.4%. Within the various subgroups, the
groups with higher disease prevalence rates were females, patients presenting
for obstetric surgery, and the younger age groups. The highest prevalence of HIV
infection was found in patients aged 30-39 years (43.0%), and the lowest
prevalence was found in patients aged 60 years or older (7.7%).
CONCLUSIONS
Routine clinical preoperative assessment in patients from a population with a high
HIV prevalence rate may result in asymptomatic, severe immune compromise
secondary to HIV infection being missed in a significant number of patients.
Further study into the perioperative outcomes of these patients is warranted.
Description
M.Med.(Anaesthesia), Faculty of Health Sciences, University of the Witwatersrand, 2008
Keywords
HIV-positive patients, anaesthesia, CD4-count