HIV and surgery

Related Terms

Acquired immune deficiency syndrome, acquired immunodeficiency syndrome, AIDS, antiretroviral therapy, antiretrovirals, appendicitis, ART, biopsy, CD4 cells, endoscope, endoscopic sphincterotomy, HAART, highly active antiretroviral therapy, HIV, human immunodeficiency virus, immune, immune defense system, immune system, immunocompromised, immunodeficiency, prostate cancer, prostate surgery, splenectomy, surgery, surgical, thoracic surgery, weakened immune system, white blood cells.

Background

Patients infected with the human immunodeficiency virus (HIV) may require surgery to treat infections and diseases associated with the condition. HIV infects white blood cells called CD4 cells. Since white blood cells are the main component of the immune system, HIV patients have an increased risk of developing infections.
With the introduction of highly active antiretroviral therapy (HAART), a combination of anti-HIV drugs, HIV patients are able to live longer lives. As a result, it is possible for HIV patients to require surgical interventions for long-term conditions.
Common complications of surgery include bleeding, infections, and nerve damage. It has been suggested that HIV patients may have an increased risk of surgical complications (especially infections) because they have weakened immune systems. However, there is currently no scientific data on the prevalence of surgical complications among HIV patients compared to non-infected patients.
Researchers believe that the risks of surgical complications for HIV patients can be predicted in a way similar to the method used in HIV-negative patients. Prior to surgery, healthcare providers should perform a physical examination, detailed medical history, and laboratory testing to determine the patient's overall health. Healthcare providers must also consider possible interactions between the patient's anti-HIV drugs (antiretrovirals) and medications, such as pain relievers, that are used before, during, and after surgical procedures.
It remains unclear whether a patient's CD4 cell count influences their risk of surgical complications. Healthy individuals have a CD4 cell count between 600 and 1,200 cells per microliter of blood. The lower the CD4 count, the weaker the patient's immune system. Some studies have found no correlation between low CD4 cell counts and surgical complications, while others have found an increase in complications with lower CD4 counts. Further research is needed before a firm conclusion can be made.

Author information

This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

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National Institute of Allergy and Infectious Diseases. HIV Infection and AIDS: An Overview. . Natural Standard: The Authority on Integrative Medicine. .
Schneider PA, Abrams DI, Rayner AA, et al. Immunodeficiency-associated thrombocytopenic purpura (IDTP). Response to splenectomy. Arch Surg. 1987 Oct;122(10):1175-8. .
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Treatment

General: Treatment for surgical complications depends on the underlying cause, as well as the patient's overall health and age. Patients should tell their healthcare providers if they are taking any other drugs (prescription or over-the-counter), herbs, or supplements because they may interact with treatment.
Antimicrobials: Medications called antimicrobials are used to treat infections that develop after surgery. Antibiotics are used to treat bacterial infections, antifungals are used to treat fungal infections, and antivirals are used to treat viral infections. The exact dose and duration of treatment depends on the type and severity of the infection, as well as the overall health of the patient.
Chest tube: If a patient suffers from a collapsed lung after lung surgery, a chest tube may need to be inserted into the chest cavity. The chest tube may need to stay in place for several days.

Integrative therapies

Unclear or conflicting scientific evidence:
Aconite: The aconite plant grows in rocky areas. Aconite has been used for neuralgia, sciatica, and rheumatism. Aconite is also an ingredient in homeopathic preparations. It is often used in homeopathy to treat cold and flu symptoms. There is limited data on the use of aconite or any of its derivatives in treating pain. Homeopathic aconite may help relieve postoperative agitation, but further information is needed to confirm these results.
Aconite is highly toxic and is not safe for human consumption. Avoid with heart disease, heart dysfunction, irregular heartbeat, abnormal blood flow, gastrointestinal disorders, ulcers, reflux esophagitis (inflamed esophagus), ulcerative colitis, spastic colitis, or diverticulosis. Use cautiously with diabetes or suicidal tendencies. Avoid if younger than 18 years old. Avoid if pregnant or breastfeeding.
Acupressure: During acupressure, finger pressure is applied to specific acupoints on the body. Acupressure is used around world for relaxation, wellness promotion, and for the treatment of many health problems. Several studies report that acupressure provides pain relief to patients after surgeries. This research suggests that acupressure may be as effective as intravenous pain medications. However, further evidence is needed from well-designed trials before a firm conclusion can be drawn.
With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific "points" that function like gates, allowing chi to flow through the body. During acupuncture, needles are inserted into these points to regulate the flow of chi. Results have been mixed for the effects of both acupuncture and electroacupuncture on pain following surgery (knee arthroscopy, back, abdominal, gastroscopy, breast, pulmonary). Thus, there is insufficient available evidence to recommend either for or against acupuncture for post-surgical pain.
Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, or neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
Arginine (L-arginine): L-arginine helps maintain the body's fluid balance and helps fight infection. It also aids in wound healing, hair growth, sperm production (spermatogenesis), and blood vessel relaxation (vasodilation). One study suggests that arginine may provide benefits when used as a supplement after surgery. It is not clear what the specific role of arginine may be in improving immune function, or what dose is safe or effective.
Avoid if allergic to arginine. Avoid with history of stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use cautiously if taking blood-thinners (such as warfarin), blood pressure drugs, or herbs or supplements with similar effects. Check blood potassium levels.
Chamomile: Chamomile is a common tea. Chamomile is a popular home remedy for many conditions, including skin and stomach discomfort. There is a lack of evidence regarding the use of chamomile for sore throat after surgery. Two randomized controlled trials compared normal saline or no lubrication to chamomile extract spray administered before intubation; however no statistical difference was noted. Additional research is needed to confirm these results.
Avoid if allergic to chamomile or any related plants such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
Choline: Choline is an essential amino acid synthesized in the body as well as consumed in the diet. The largest dietary source of choline is egg yolk. There is a lack of sufficient evidence regarding the use of choline in patients recovering from surgery. Further research is necessary to determine whether choline is beneficial for patients who recently underwent surgery.
Avoid if allergic/hypersensitive to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver disorders or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding, it seems generally safe to consume choline within the recommended adequate intake (AI) parameters; supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
Creatine: Creatine is often used as a bodybuilding supplement. Some research supports the use of creatine for certain neuromuscular diseases, chronic heart failure, enlarging muscle mass, and hyperornithinemia. There is early evidence that heart muscle may recover better and more rapidly after open-heart surgery if intravenous creatinine is administered during the operation. Further study is needed before a recommendation can be made.
Avoid if allergic to creatine or if taking diuretics such as hydrochlorothiazide or furosemide (Lasix?). Use cautiously with a history of asthma, diabetes, gout, kidney, liver problems, muscle problems, or stroke. Avoid dehydration. Avoid if pregnant or breastfeeding.
Guided imagery: Guided imagery refers to a number of techniques including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, and direct suggestion using imagery. Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. Initial evidence suggests that guided imagery relaxation audiotapes may reduce anxiety after surgeries and may improve healing. More study is needed before a recommendation can be made.
Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms. If feeling unusually anxious while practicing guided imagery, or if a history of trauma or abuse, speak with a qualified healthcare provider before practicing guided imagery.
Healing touch: Healing touch (HT) is a combination of hands-on and off-body techniques to influence the flow of energy through a person's biofield. Data from two small studies are inconclusive as to whether HT can benefit patients with post-operative pain. Studies of better design are needed before definitive recommendations for or against HT can be made.
HT should not be regarded as a substitute for established medical treatments. Use cautiously if pregnant or breastfeeding.
Hypnotherapy, hypnosis: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Research suggests that hypnosis may be helpful for pain and anxiety in various situations, including after surgery. Early research reports that length of hospital stay and psychological well being may be improved after surgery with the use of hypnotherapy. However, most studies in this area are not well designed and updated high-quality investigations are needed before a firm conclusion can be drawn.
Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders. Use cautiously with seizure disorders.
Liver extract: Liver extract is processed cow or pig liver that may either be a freeze-dried brownish powder or a concentrated liquid that has had most of the fat and cholesterol removed. Liver extract may help maintain liver function during urological surgery. More research is needed to define the importance of this normalization of liver function.
Avoid if allergic or hypersensitive to liver extract or its constituents. Use cautiously if taking antacids or with acid reflux. Use cautiously with clotting disorders, compromised immune function, or abnormal iron levels. Use cautiously if taking drugs that affect blood cholesterol, antivirals (especially interferon), or any agents for cancer. Use liver extract cautiously as raw liver may contain liver flukes or the bacterium, Vibrio fetus. Use cautiously in patients with liver disease or with reduced human growth hormone metabolic clearance rate. Avoid liver extract with iron metabolism disorders or iron shortage disorders, such as hemochromatosis. Avoid liver extract from countries where bovine spongiform encephalitis (BSE or "mad cow disease") has been reported. Avoid if sensitive to liver extract or any of its components, as liver extract therapy has caused severe anaphylactic shock. Avoid if pregnant or breastfeeding.
Massage: Many different forms of massage have been practiced to promote well-being, relaxation, pain-reduction, stress-relief, musculoskeletal injury healing, sleep enhancement, and quality of life. Various massage approaches have been used after surgery with the aim of improving recovery and decreasing pain. Further study is needed in this area before a recommendation can be made.
Avoid with bleeding disorders, low platelet counts, or if on blood-thinning medications (such as heparin or warfarin/Coumadin?). Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
Nasal irrigation: Nasal irrigation is used to clear the sinuses. It can be performed by the patient at home or by a professional up to twice daily. Yoga enthusiasts have used nasal irrigation for thousands of years to clear both the sinus cavity and the mind. Cleaning the inside of the nose with saline solution after endonasal sinus surgery is often used for postoperative treatment, although the efficiency and acceptance of this method has not been examined thoroughly. There is some supportive evidence from one randomized trial, a case series, and an equivalence trial for the use of nasal irrigation to remove infectious microorganisms in postoperative care after nasal (including polypectomy) or sinus surgeries. These studies are lacking in the performance or description of statistical analysis. A randomized controlled trial with statistical analysis is needed to reveal further information.
Nasal irrigation is generally well tolerated. Use cautiously with history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury by using a variety of methods, including exercises, stretches, traction, electrical stimulation, and massage. Physical therapy techniques are often used following cardiopulmonary bypass surgery, abdominal surgery, and other surgical procedures, as well as for the prevention of pulmonary complications. Several studies do not show any difference between various chest physiotherapy treatments, such as incentive spirometry, intermittent positive pressure breathing (IPPB), or deep breathing exercises. Overall, it is difficult to compare treatment outcomes across the various studies and more high-quality studies are needed to make a firm recommendation.
Not all physical therapy programs are suited for everyone. Patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, complications are possible. Treatment options should be considered carefully. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy, specifically to treat women with pelvic girdle pain during pregnancy and at three, six, and 12 months postpartum. Reports of major adverse effects are lacking in the available literature, but caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
TENS (transcutaneous electrical nerve stimulation): TENS (transcutaneous electrical nerve stimulation) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Auricular (ear) TENS is sometimes used in Europe to reduce the need for anesthesia during surgical procedures. There is not enough reliable evidence to draw a firm conclusion in this area
There are multiple controlled studies of TENS for pain following various types of surgery, including abdominal surgery, heart surgery, lung surgery, gynecologic surgery, and orthopedic surgery. Research is inconsistent, with a variety of TENS techniques, patient types, and study designs used. Overall, the quality of available research is poor. Although some studies do report improvements in pain and reduced need for pain medications, a well-designed review in 1996 concluded that there is no clear evidence of benefit. Better quality research is necessary in this area before a strong conclusion can be reached.
Avoid with implantable devices, such as defibrillators, pacemakers, intravenous (IV) infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
Fair negative scientific evidence:
Beta-carotene: Beta-carotene is naturally found in many fruits, grains, oil, and vegetables (such as green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Study results conclude that supplementation before surgery with antioxidant micronutrients has limited effects on strength and physical function following major elective surgery.
Avoid if allergic or hypersensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products.
Creatine: Creatine is often used as a bodybuilding supplement. Some research supports the use of creatine for certain neuromuscular diseases, chronic heart failure, enlarging muscle mass, and hyperornithinemia. In two studies investigating the effect of creatine supplementation in individuals undergoing soft tissue surgery, no effect was noted on strength or body composition. Creatine supplementation is likely ineffective given this information and recommendations cannot be made in this field without further study.
Avoid if allergic to creatine or with diuretics (such as hydrochlorothiazide, furosemide). Use cautiously with history of asthma, diabetes, gout, kidney, liver problems, muscle problems, or stroke. Avoid dehydration. Avoid if pregnant or breastfeeding.

Prevention

Patients can help prevent surgical complications from occurring. Before surgery, patients should follow the instructions of their healthcare providers. For instance, many surgeries require patients to abstain from food 24 hours before surgery.
Patients should tell their healthcare providers if they are taking any drugs (over-the-counter or prescription), herbs, or supplements because they may interact with medications used before, during or after the surgery. For instance, some drugs and herbs affect blood clotting, which could increase the risk of bleeding during surgery.
Patients should closely follow their healthcare provider's instructions on how to care for their wounds after surgery. Surgical wounds should be kept clean and monitored for signs of infection (e.g. swelling, reddening, pain). Patients may need to limit physical activity while they heal. Also, patients should avoid close contact with individuals who may be sick or have infections.

Types of surgery

Abdominal surgery:
Infections associated with HIV may require surgical diagnostic tests. For instance, a laparoscopy is a diagnostic procedure that involves surgery. During this procedure, the patient receives general anesthesia and a small incision is made in the abdomen. A viewing tube called a laparoscope is then inserted through the incision. This allows the healthcare provider to view the inside of the abdomen. This procedure has been used to diagnose conditions, including a bacterial infection called abdominal tuberculosis. Because there is a slight risk of bleeding and infection, this procedure should only be performed when all other diagnostic tests are inconclusive.
Appendicitis (inflamed appendix) requires the surgical removal of the organ. In most cases, feces block the inside of the appendix, causing it to swell. Bacterial or viral infections in the digestive tract, which are common among HIV patients, may lead to enlarged lymph nodes. The swollen lymph nodes then squeeze the appendix, causing obstruction. HIV-positive and HIV-negative patients generally experience the same symptoms, including severe abdominal pain, nausea, and vomiting. However, the condition may be more difficult to diagnose in HIV patients. Since HIV destroys the white blood cells, HIV patients do not have high levels of white blood cells, which is a characteristic of appendicitis. This may lead to a delay in diagnosis and surgery, resulting in an increased risk of death.
Anorectal surgery:
Anorectal (related to the anus and/or rectum) diseases are common among HIV patients and may require surgery.
Condylomas are wart-like growths around the anus, vulva, or tip of the penis. HIV patients who have the human papillomavirus (HPV) typically develop these warts in the perianal region. The warts may be flat or cauliflower shaped. Small warts may spontaneously resolve. Lesions can be removed at a doctor's office with a scalpel, by electrosurgery, laser ablation, or liquid nitrogen. While these procedures have been shown to be safe for HIV patients, surgical removal of the warts does not cure the virus or prevent future outbreaks.
HIV patients who have hemorrhoids may need to have them surgically removed. The procedure, called hemorrhoidectomy, is considered safe for HIV patients. However, wound healing may be delayed in patients with low CD4 cell counts.
Biliary tract surgery:
The biliary tract is a system of organs and ducts that are involved in the production and transportation of bile from the liver to the small intestine. Bile, which is stored in the gallbladder, helps breakdown fats from digested food. Opportunistic infections associated with HIV, including cytomegalovirus and mycobacterium avium complex (MAC), may infect the gallbladder and bile duct. The most common cause of biliary tract disease is cholelithiasis, also called gallstones.
Gallstones develop when liquid in the gallbladder (called bile) hardens and becomes stone-like. Sometimes gallstones are too large for the patient to excrete in the urine. The stone becomes stuck inside the tubes in the gallbladder. In such cases, surgery is necessary to remove the gallstone. A procedure called endoscopic sphincterotomy is most often performed. During the procedure, which is performed at a hospital, the patient receives general anesthesia. Then, a thin, flexible tube called an endoscope is inserted through the patient's anus. Additional surgical tools are inserted through the tube to remove the gallstone.
In general, this procedure is considered safe and effective for HIV patients with gallstones that cannot be passed naturally. It is estimated that five to 10% of all patients (HIV-positive and HIV-negative) experience complications from endoscopic sphincterotomy. It is unknown whether this risk is higher among HIV patients. Common complications include inflammation of the pancreas (pancreatitis), inflammation of the bile ducts (cholangitis), bleeding, and passage of bacteria into the bloodstream.
Brain surgery:
Patients with HIV may develop brain lesions as a result of toxoplasmosis (a parasitic infection), brain abscesses (infection in the brain), or cancer of the central nervous system (brain and spinal cord).
Brain surgery is a serious and risky procedure for all patients, not just those who have HIV. It remains unclear whether HIV patients have an increased risk of developing complications during or after brain surgery. Complications of brain surgery may include bleeding, infection, brain tissue damage, blood vessel damage, loss or impairment of mental functions (e.g. memory, speech), nerve damage, and muscle paralysis or weakness. Brain surgery should only be performed if the potential health benefits outweigh the risks. Patients should make educated decisions about surgery after discussing the potential risks with their healthcare providers.
Toxoplasmosis is the most common cause of brain lesions in HIV patients. In rare cases, especially if patients do not respond to treatment, a brain biopsy may be necessary to confirm a diagnosis. During this surgical procedure, the patient receives anesthesia so he/she cannot feel pain. The neurosurgeon drills a small hole into the patient's skull and inserts a thin needle to remove a small tissue sample from the brain. The sample is then analyzed in a laboratory to check for the presence of the disease-causing parasite. A brain biopsy is an invasive procedure that is associated with serious health risks, including brain injury, and therefore should only be performed when all other diagnostic procedures are inconclusive.
Cesarean section:
Although a cesarean section (surgical delivery of a baby), also called a C-section, can reduce the risk of HIV transmission to the newborn during birth, it is not typically necessary in patients who undergo antiretroviral therapy. However, mothers who have high levels of the virus in their blood may reduce the risk of transmitting the virus to their babies if they undergo a C-section.
Patients should discuss the potential risks and benefits of a C-section. It has been suggested that HIV patients may have an increased risk of experiencing complications of C-sections because they have weakened immune systems. However, there is insufficient evidence comparing the prevalence of surgical complications among HIV-positive and HIV-negative patients.
One study found that HIV-negative women who had C-sections were twice as likely to be re-hospitalized after giving birth than women who had vaginal deliveries. Most of these hospitalizations were for uterus infections.
The same researchers concluded that, on average, women who undergo C-sections lose about twice as much blood than women who had vaginal deliveries.
Organ transplants:
Until recently, people who had HIV were not considered good candidates for organ transplantations. Many patients were denied transplants under the assumption that they had shorter life expectancies and less favorable survival rates than other patients in need of transplants. However, now that patients are living longer lives, many groups are reconsidering whether HIV patients should be transplant candidates.
Although the United Network for Organ Sharing (UNOS) does not consider HIV infection a contraindication for organ transplantation, the decision to perform transplantation in an HIV-positive individual rests with individual centers. Some centers will not provide organ transplants to good candidates who are HIV-positive.
Some health insurance companies are reluctant to cover transplantation in HIV-positive candidates because they consider it to be an experimental procedure. Currently, only a few medical centers worldwide perform organ transplants in HIV-positive patients.
Recent legislation in California and a ruling in Arizona may help increase HIV patients' access to transplant surgery. In October 2005, an administrative law judge declared that Medicaid had to pay for a liver transplant for an Arizona woman who was HIV-positive. In the same month, California Governor Arnold Schwarzenegger signed a law that prohibits health insurance companies from denying coverage for organ transplants in HIV patients solely on the basis of their HIV-status. The law is the first of its kind to target such denials.
The limited number of transplants that have been performed in HIV patients have produced encouraging results. However, organ transplants for patients with HIV/AIDS have not gained widespread medical support, and there are still concerns regarding the long-term prognosis for HIV-positive transplant recipients.
Prostate surgery:
Until recently, scientific evidence on the safety and efficacy of surgical procedures for HIV patients with prostate cancer was inconclusive. Currently, it appears that HIV patients who have prostate cancer do not have an increased risk of developing complications from surgery when compared to HIV-negative patients. Studies have found that HIV patients can safely undergo prostate surgery, as long as they are otherwise healthy. HIV patients should not undergo surgery unless they have reasonably stable CD4 cell counts, an indicator of how the health of the immune system.
Splenectomy (surgical removal of the spleen):
Idiopathic thrombocytopenic purpura, also called immune thrombocytopenic purpura, occurs when the body's immune system mistakenly destroys platelets (blood cells that help with clotting) in the spleen. In general, HIV patients do not respond as well to corticosteroid treatment as HIV-negative patients. Some HIV patients require a splenectomy (surgical removal of the spleen) to treat this condition.
In general, this procedure has been shown to be safe and effective for HIV patients who do not have advanced HIV. After surgery, most patients experience an increase in both their platelets counts and their CD4 cell counts.
According to one study, which involved 21 HIV patients, splenectomy did not increase the risk of patients progressing to AIDS.
Thoracic (chest) surgery:
Since HIV infects and destroys immune cells in the body, HIV patients are vulnerable to a multitude of infections. Lung infections, which may be caused by Pneumocystis jiroveci pneumonia (formerly called Pneumocystis carinii pneumonia, PCP), mycobacterium avium complex (MAC), tuberculosis, and fungal infections often require invasive diagnostic procedures, such as bronchoalveolar lavage or an open lung biopsy. Like any surgical procedure, there are potential heath risks. It remains unclear whether HIV patients are more likely to develop complications than HIV-negative patients.
Bronchoalveolar lavage: A bronchoalveolar lavage (BAL) is commonly performed to determine whether patients have lung infections, such as PCP. During the procedure, a thin, flexible tube, called a bronchoscope, is passed through the mouth or nose and into the lungs. Saline is squirted into a small part of the lung and then collected for analysis. Common complications include infection and bleeding.
Transbronchial biopsy: During a transbronchial biopsy, a bronchoscope is inserted through the patient's mouth or nose and into the lungs. Then, tiny forceps are inserted into the hollow tube of the bronchoscope. A small amount of lung tissue is removed for analysis. Patients may need to stay overnight at the hospital after the procedure is performed.
Pneumothorax, an accumulation of air between the outer lining of the lung and the chest wall that causes the lung to collapse, occurs in about two percent of transbronchial biopsies. There is also a risk of bleeding and infection after the procedure.
Open lung biopsy: An open lung biopsy is a diagnostic procedure with 100% sensitivity and specificity because it provides the greatest amount of tissue for diagnosis. However, since a lung biopsy is the most invasive test, it should only be performed when all other diagnostic tests are inconclusive. The procedure is performed in a hospital while the patient is under general anesthesia. A tube will be placed through the mouth and into the airway that leads to the lungs. After cleaning the skin, the surgeon makes a cut in the chest area and removes a small piece of lung tissue. The wound is closed with stitches. A chest tube may be left in place for one to two days to prevent the lung from collapsing. The tissue sample is taken to a laboratory for analysis.
Complications are more likely to occur in patients who have lung diseases or severe breathing problems. Complications associated with open lung biopsies include infection, bleeding, pneumothorax, spasms of the bronchial tubes, and irregular heartbeat.