Excellent Heart Surgery Outcomes in HIV Positive Patients

With the widespread use of highly active antiretroviral therapy (HAART), more HIV positive individuals are living to the age at which cardiovascular disease typically occurs; antiretroviral drugs, however, may also increase the risk of heart disease by causing elevated lipid levels and blood glucose abnormalities.

Prior to the advent of HAART, many experts were hesitant to recommend cardiac surgery for people with HIV. But a recent study, published in the August 15, 2006 issue of Clinical Infectious Disease, found that HIV positive individuals -- especially those with higher CD4 cell counts - had heart surgery outcomes similar to those of HIV negative people.

Researchers at Mount Sinai Medical Center in New York City conducted a retrospective analysis of medical records from 4,952 patients who received open-heart surgery between 1998 and 2004. The most common indications for surgery were endocarditis, or infection of the heart linings or valves (56%), and coronary artery disease (28%).

Results

25 of the individuals undergoing heart surgery were HIV positive, and 13 of these were on antiretroviral therapy at the time of surgery.

40% had CDC Category 1 HIV disease (CD4 count > 500 cells/mm3), 44% had Category 2 disease (CD4 count 200-499 cells/mm3), and 16% had Category 3 disease (CD4 count < 200 cells/mm3).

Only 1 patient died in the hospital following surgery.

Among the remaining 24 individuals, after a mean 4 years of post-surgery follow-up, the survival rate was 87.5% -- similar to that of HIV negative individuals.

2 of the 3 patients who died during follow-up had Category 2 or 3 HIV disease at the time of surgery.

Post-surgical complications (e.g., excessive bleeding, infections, kidney failure) occurred only among individuals with various risk factors, including low CD4 cell count, pre-existing kidney or liver disease, and coinfection with hepatitis C virus (HCV).

Conclusion

The researchers concluded that this study produced the most favorable results to date concerning heart surgery in people with HIV, which they attributed to a combination of better HIV treatment and improved heart surgery techniques.

09/01/06

Reference
F Filsoufi, S P Salzberg, K T Harbou, and others. Excellent outcomes of cardiac surgery in patients infected with HIV in the current era. Clinical Infectious Diseases 43(4): 532-536. August 15, 2006.