Surgical pathology of HIV infection: lessons from Africa

Abstract

Human immunodeficiency virus has resulted in a major change in the presentation and behaviour of certain common diseases in Africa. This review describes some of the important changes and discusses the implications for management.

PIP: The experience of surgeons in Africa with patients infected with human immunodeficiency virus (HIV) suggests 5 trends: 1) an increased incidence of surgical sepsis--most commonly in the female genital tract, the pleural cavity, large joints, and the anorectal area--in HIV-infected patients; 2) an increase in surgical tuberculosis of spine, bone joints, lymph nodes, and the peritoneal cavity concomitant with an increased incidence of pulmonary tuberculosis in high-incidence countries; 3) impaired healing of wounds, wound breakdown, and the development of skin lesions and ulcers; 4) tumors whose aggressiveness is accelerated by HIV infection; and 5) new pathologies such as nonspecific cystitis, chronic osteitis, and vascular disease. In many cases, HIV infection has not been identified until after hospital patients have demonstrated a rapid, progressive decline after routine surgery. To date, only 1 study has attempted to determine the extent to which HIV infection influences the outcome of surgery. Mortality in an intensive care unit at the University Teaching Hospital in Lusaka, Zambia, differed significantly between HIV-positive and seronegative patients only in terms of pneumonia; however, seropositive patients also have an elevated, albeit nonsignificant, risk of mortality from severe gynecologic sepsis.