Preoperative counts of CD4 T-lymphocytes and early postoperative infective complications in HIV-positive patients.

Objective: To assess the relationship between postoperative infective complications and the CD4 count.

Design: Retrospective and biometric study.

Setting: Two university hospitals, Switzerland.

Subject: 40 HIV-positive patients who had had CD4 counts done during the three months before operation.

Interventions: Clean and contaminated gastrointestinal and orthopaedic procedures.

Main Outcome Measure: Postoperative infective complications.

Results: 15 patients developed postoperative infective complications (38%), 6 of which (40%) were HIV-related. CD4 cell count, as well as the type of operation (contaminated or clean), influenced the infective complication rate. The risk of infective complications after a contaminated procedure when the CD4 count was below 200 mm3 was more than 50%. In clean operations, even when the CD4 cell count was close to 0, the rate of infective complications was never as high as 50%. Patients with a CD4 cell count of 500 or more have a similar rate of infective complications as HIV seronegative patients.

Conclusion: Indications for operation in HIV-positive patients must take into account the CD4 cell count and the type of operation.