Common Surgical Conditions In Hiv

Overview of surgical conditions in HIV/AIDS Ruth Obaikol

lymphadenopathy 

Differentials    

TB Reactive lymphadenopathy Kaposi’s sarcoma Lymphoma

pyomyositis     

Currently common in age 21-40 M>F 61.3% HIV +ve. Multiple and recurrent Staph – commonest pathogen

OTHER INFECTIONS  

Abscess: psoas abscess Gangrene

Kaposi’s sarcoma      

epidemic disease Aggressive and extensive Age of onset M 35 F 25 M>F 4:1 Cutaneous or visceral Assoc with HHV 8

Acute onset  Symmetrical LAP  Early death PRESENTATION 

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Skin nodules Plaques Assoc. oedema

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LAP Visceral lesions Combinations

Relapses are common Wide spread disease may be resistant to medication.

Ano rectal conditions 

Common presentation;     

Pruritus ani Anal Pain Rectal bleeding Difficulty in passing stool Faecal impaction

Ano-rectal conditions 

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Anal condyloma acuminata caused by HPV 6 & 11 may be hidden got by DRE Squamous cell carcinoma Anorectal KS

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Fissure in ano 

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Can follow hard stool/ chronic diarrhea

Anal abscess 

Pain, tender fluctuant swelling assoc fever

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Fistula in ano 

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May or may not follow abscesses

Anal ulceration secondary to HSV, TB, syphilis. Hemorrhoids

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MANAGEMENT 

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Stage I and II just like general population Stage III and IV – conservative exception; abscesses

ACUTE ABDOMEN 

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50% OF HIV pts develop GI manifestations. 2x the non HIV pts are admitted 8% need intrabdominal procedures

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Common causes;     

Cytomegalovirus colitis Intra abdominal lymphoma Atypical mycobacteria Abd TB Acalculus cholecystitis

PRESENTATION 

PAIN; occurs at different sites    

Right upper quadrant Epigastric +/- jaundice Right illiac fossa pain Diffuse abdominal pain

MANAGEMENT 

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If the diagnosis is straight forwardmanage as HIV negative patients CDC group IV 

Careful conservative/ non operative management.

Vascular 

Dry gangrene ass. with vasculitis

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Management 

Amputation

Cardiothoracic The most common complications of pulmonary tuberculosis  Empyema thoracis  Pericardial effusions

Pleural effusion 

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Zambia- 66 to 81 % of patients with TB pleural disease were HIV +ve Treatment  

Thoracostomy Chest widow

Pericardial effusion   

99.9% pts HIV +ve TB origin Surgery indicated in  

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cardiac tamponade Constrictive pericarditis

Operations  

Thoracocentesis Subxiphoid pericardiectomy

Neural surgery 

Intracranial mass lesions   

Toxoplasmosis Brain abscess Primary CNS Lymphomas

Transplant surgery 

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4-7% of patients develop end stage renal failure Higher mortality on dialysis 

Benefit from transplant

Pts with HIV have HBV and HCV co infection – liver failure 

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May benefit from liver transplant

Urology  

Renal abscess 50-60% circumcised men are less likely to get HIV during heterosexual sex.

summary 

The role of surgery in HIV is    

Diagnostic Curative Palliative preventive