Overview of surgical

conditions in HIV/AIDS

Ruth Obaikol
lymphadenopathy
 Differentials
 TB
 Reactive lymphadenopathy
 Kaposi’s sarcoma
 Lymphoma
pyomyositis
 Currently common in age 21-40
 M>F
 61.3% HIV +ve.
 Multiple and recurrent
 Staph – commonest pathogen
OTHER INFECTIONS
 Abscess: psoas abscess
 Gangrene
Kaposi’s sarcoma
 epidemic disease
 Aggressive and extensive
 Age of onset M 35 F 25
 M>F 4:1
 Cutaneous or visceral
 Assoc with HHV 8
 Acute onset
 Symmetrical LAP

 Early death

PRESENTATION
 Skin nodules
 Plaques
 Assoc. oedema
  LAP
 Visceral lesions
 Combinations
 Relapses are common
 Wide spread disease may be
resistant to medication.
Ano rectal conditions
 Common presentation;
 Pruritus ani
 Anal Pain
 Rectal bleeding
 Difficulty in passing stool
 Faecal impaction
Ano-rectal conditions
 Anal condyloma acuminata
caused by HPV 6 & 11
may be hidden got by DRE
 Squamous cell carcinoma

 Anorectal KS
 Fissure in ano
 Can follow hard stool/ chronic
diarrhea

 Anal abscess
 Pain, tender fluctuant swelling assoc
fever
 Fistula in ano
 May or may not follow abscesses
 Anal ulceration secondary to HSV,
TB, syphilis.
 Hemorrhoids
 MANAGEMENT
 Stage I and II just like general
population
 Stage III and IV – conservative
 exception; abscesses
ACUTE ABDOMEN
 50% OF HIV pts develop GI
manifestations.
 2x the non HIV pts are admitted
 8% need intrabdominal procedures
 Common causes;
 Cytomegalovirus colitis
 Intra abdominal lymphoma
 Atypical mycobacteria
 Abd TB
 Acalculus cholecystitis
PRESENTATION
 PAIN; occurs at different sites
 Right upper quadrant
 Epigastric +/- jaundice
 Right illiac fossa pain
 Diffuse abdominal pain
MANAGEMENT
 If the diagnosis is straight forward-
manage as HIV negative patients
 CDC group IV
 Careful conservative/ non operative
management.
Vascular
 Dry gangrene ass. with vasculitis

 Management
 Amputation
Cardiothoracic
The most common complications of
pulmonary tuberculosis
 Empyema thoracis

 Pericardial effusions
Pleural effusion
 Zambia- 66 to 81 % of patients
with TB pleural disease were HIV
+ve
 Treatment
 Thoracostomy
 Chest widow
Pericardial effusion
 99.9% pts HIV +ve
 TB origin
 Surgery indicated in
 cardiac tamponade
 Constrictive pericarditis
 Operations
 Thoracocentesis
 Subxiphoid pericardiectomy
Neural surgery
 Intracranial mass lesions
 Toxoplasmosis
 Brain abscess
 Primary CNS Lymphomas
Transplant surgery
 4-7% of patients develop end
stage renal failure
 Higher mortality on dialysis
 Benefit from transplant
Pts with HIV have HBV and HCV
co infection – liver failure
 May benefit from liver transplant
Urology
 Renal abscess
 50-60% circumcised men are less
likely to get HIV during
heterosexual sex.
summary
 The role of surgery in HIV is
 Diagnostic
 Curative
 Palliative
 preventive