Effect of emergency major surgery on CD4 cell count in HIV positive and negative patients in Mulago hospital: A prospective cohort study

Abstract

Surgery has a key role in HIV palliative care, specifically in the diagnosis (e.g laparotomy) and treatment (e.g excision of tumor) of HIV related and non related conditions. Yet major surgery, a form of trauma depresses the immune system. Whereas the surgical consequencies of HIV infection are well described, there is s paucity of published data, particulary in resource limited settings, on the effects of major surgery on the immune system. The key method of evaluating the state of immune infection, especially the cell mediated arm in measuring the CD4 cell counts. The general objective was to determine the effect of major surgery on CD4 count in HIV positive and HIV negative patients after emergency major surgery in mulago hospital. The specific objectives were; 1. To determine the median reduction in CD4 cell count in HIV positive patients after major surgery in 1st and 7th post operative days 2. To determine the median reduction in CD4 cell count in HIV negative patients after major surgery on 1st and 7th post operative days 3. To compare the median reductions of CD4 cell count in HIV positive and HIV negative patients on 1st and 7th post operative days following major surgery. METHODS: The study was a prospective cohort study following 25 HIV positive and 76 HIV negative patients, a total of 101 patients who were due for emergency major surgery in mulago hospital. Their CD4 counts were done pre-operatively, on the 1st post operative day and on the 7th post operative day. The patients were recruited from the causality department which is the accident and emergency department of mulago hospital and the emergency surgical ward 3BES in Mulago hospital where patients for emergency surgery are admitted. Their blood was drawn for HIV screening, CD4 cell count and CBC before the emergency surgery was done. Data was collected using pre-coded and pre-tested questionnaires, entered into a computer using Epi data 3.1 and analysed using stata 10. Base line characteristics between HIV positive and negative patients were compared. Medians were used for most of the data since it was not normally distributed. Mann Whitney test of significance was used for continuous data and fisher; exact test used for small categorical data.

RESULTS: The study had a sample size of 101 patients, 25 of them HIV positive and 76 HIV negative. The median CD4 cell reduction between the pre-operative day and 1st post operative day was higher in the HIV negative group (-68 cells) than in the HIV positive group (-29 cells). This result was not statistically significant (p- 0.4764). Between the 1st and 7th post operative day, there was a general increase in the median CD4 change by 72 cells for the HIV positives and 95 cells for the negative. (P-0.4383) CD4 change between the pre operative and 7th post operative days rose in both the HIV positive and negative groups by 27 cells for the HIV positives and 28 cells for the HIV negatives. P-0.9373 Relative risk in the study was 0.96, C1 {0.6025-1.5296} CONCLUSION: Major surgery has no statistically significant effect on CD4 cell count in HIV positive patients compared to HIV negative patients undergoing emergency major surgery in mulago hospital. There is no association between HIV infection and CD4 cell reduction in patients having emergency major surgery in our setting (Mulago hospital).