Increased mortality at all CD4 cell count strata, although absolute incidence is low
WEDNESDAY, Feb. 25, 2015 (HealthDay News) — Patients with HIV infection receiving antiretroviral therapy (ART) have increased 30-day postoperative mortality versus uninfected patients, although absolute incidence is low, according to a study published online Feb. 25 in JAMA Surgery.
Joseph T. King Jr., M.D., from the Veterans Affairs Connecticut Healthcare System in West Haven, and colleagues compared 30-day postoperative mortality in patients with HIV infection receiving ART with rates in uninfected individuals. Data from the U.S. Veterans Health Administration Healthcare System were obtained for Oct. 1, 1996, to Sept. 30, 2010, for 1,641 patients with HIV infection receiving combination ART and undergoing inpatient surgery and for 3,282 procedure-matched uninfected controls.
The researchers found that 30-day postoperative mortality was higher for patients with HIV infection versus uninfected patients (3.4 versus 1.6 percent; incidence rate ratio [IRR], 2.11; P < 0.001). There was an inverse association for CD4 cell count with mortality; HIV-1 RNA provided no additional information. Patients with HIV infection had increased mortality compared with uninfected patients at all CD4 cell count strata, after adjustment. Strong associations were also seen for hypoalbuminemia (IRR, 4.35) and age in decades (IRR, 1.47) with mortality.
“Current postoperative mortality rates among individuals with HIV infection who are receiving ART are low and are influenced as much by hypoalbuminemia and age as by CD4 cell status,” the authors write. “Human immunodeficiency virus infection and CD4 cell count are only two of many factors associated with surgical outcomes that should be incorporated into surgical decision-making.”
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