Page 207 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 6 Original Research

HIV status and mortality of surgical inpatients in rural

Zimbabwe: A retrospective chart review

Authors: Background: People living with HIV treated with antiretroviral therapy (ART) are now living
Pascal Migaud 1 longer and thus many are requiring surgical procedures. For healthcare resource planning, it
Michael Silverman 2
Paul Thistle would be helpful to better understand the prevalence of HIV in surgical patients, the types of
3,4
surgery HIV-positive patients are undergoing and whether HIV status impacts mortality.
Affiliations:
1 Department of Infectious Objective: The goal of this study was to determine the prevalence of HIV in surgical inpatients
Diseases and and the extent of ART coverage, as well as to assess any differences between HIV-positive and
Gastroenterology, Vivantes HIV-negative patients in type of surgery undergone and in-hospital mortality at Karanda
Auguste-Viktoria-Klinikum,
Germany Mission Hospital, Mount Darwin, Zimbabwe.
Method: A 1-year retrospective chart review was undertaken to collect clinical and demographic
2 Department of Infectious
Disease, Faculty of Medicine, data for adult (excluding maternity cases) and paediatric surgical inpatients including age,
Western University, Canada sex, type of surgery, HIV status, CD4+ counts and, if patient was HIV-positive, whether he or
she was taking ART.
3 Department of Obstetrics
and Gynaecology, Karanda Results and conclusion: Charts for 1510 surgical inpatient stays were reviewed. HIV
Mission Hospital, Zimbabwe prevalence among the adults was higher than that in the general population in Zimbabwe in
2016 (23.2% vs. 14.7%). There was no significant difference in inpatient mortality between the
4 Department of Obstetrics HIV-negative group and the HIV-positive group. Within the group of patients with
and Gynaecology, Faculty of malignancies, people living with HIV were significantly younger than uninfected patients
Medicine, University of
Toronto, Canada (mean age 50.5 vs. 64.4 years; p < 0.01). There were correlations between HIV and certain
malignancies. Thus, in addition to AIDS-defining illnesses, clinicians must be alert to squamous
Corresponding author: cell carcinoma and oesophageal, anal and penile cancers in HIV-positive patients.
Pascal Migaud,
paco_migaud@web.de
Dates: Introduction
Received: 31 Oct. 2017
Accepted: 13 Sept. 2018 With antiretroviral therapy (ART) extending the life expectancy of patients with human
Published: 24 Jan. 2019 immunodeficiency virus (HIV), more HIV-positive patients are undergoing surgical procedures.
One review in sub-Saharan Africa (SSA) from 2016 reported that HIV prevalence in surgical
How to cite this article: patients was higher than in the general population. Because of the lack of universal testing, many
1
Migaud P, Silverman M,
Thistle P. HIV status and patients are not aware of their status; the rate of testing in surgical inpatients has been reported to
mortality of surgical be as low as 10.0% – 12.0%. 2
inpatients in rural Zimbabwe:
A retrospective chart review. In comparison to HIV-negative patients, HIV-infected patients are more likely to have to undergo
S Afr J HIV Med. 2019;20(1),
3
a812. https://doi.org/ surgery to treat infectious complications, such as abscesses or Fournier’s gangrene. Besides the
10.4102/sajhivmed.v20i1.812 well-known AIDS-defining malignancies such as Kaposi’s sarcoma, non-Hodgkin’s lymphoma
(NHL) or invasive cervical cancer, which were added to the Centers for Disease Control’s list of
Copyright: AIDS-defining conditions in 1993, there is growing evidence that there is a link between other
© 2019. The Authors.
3
Licensee: AOSIS. This work malignancies and HIV. Lung, liver and anal cancers are more common in HIV-positive patients
is licensed under the and often present at a more advanced stage or at an earlier age compared to the general population.
4
Creative Commons To plan for surgical services and training of healthcare professionals, we need to better understand
Attribution License.
the types of surgery HIV-positive patients are likely to require and how HIV status impacts
mortality.
In 2016, the prevalence of HIV in adults (aged 15–49 years) in Zimbabwe was 14.7%, which
was among the five highest rates in SSA. Antiretroviral therapy coverage has been dramatically
5
increased, but the 90-90-90 goal of the Joint United Nations Programme on HIV/AIDS (UNAIDS)
Read online: and the World Health Organization (WHO) – which stipulates that by 2020, 90% of
Read online:
Scan this QR individuals would be aware of their HIV status, 90% of those who are HIV-positive should be
Scan this QR
code with your
code with your on ART and 90% of those treated should have achieved viral suppression – has not yet been
smart phone or
smart phone or
mobile device
mobile device reached. HIV prevalence among surgical patients and its impact on outcomes has not been
6
to read online.
to read online.
documented in Zimbabwe.
http://www.sajhivmed.org.za 200 Open Access