Cardiac surgery in human immunodeficiency virus (HIV) carriers

Publisher Website
Google Scholar
Abstract
Intravenous drug addicts have always been at risk for acquiringinfective endocarditis. In the United States in recent years, as many as50% of addicts have become infected also with the human immunodeficiencyvirus (HIV). Since testing became available in late 1984, we have knowinglyperformed open cardiac surgery for endocarditis 11 times in HIV-positivepatients. In 7, signs of infection were still presented at the time ofsurgery. Four died within 2 months of continued or recurrent sepsis. Theothers are alive, although 1 has returned to IV drug abuse. Open heartsurgery was performed 4 times in patients whose endocarditis had been curedby antibiotics but who were left with destroyed valves and severecongestive cardiac failure. All these patients left hospital alive andwell. One has since died of AIDS. Ten addicts with endocarditis coming tosurgery in the pre-AIDS era had similar valvular pathology but only 2 withuncontrolled infection. All were cured by the combination of antibioticsand surgery. Conclusions: in HIV-positive patients with endocarditis,continued sepsis despite appropriate antibiotic therapy signals apotentially very serious prognosis which may be due to an already seriouslyimpaired immune state. By contrast, in the absence of uncontrolledinfection, HIV-positive patients appear to have a normal response to opencardiac surgery. Data on the risk to the patient of progressing to AIDS andthe risk to the surgical team of acquiring HIV infection are unknown.Testing is vital for answering these questions.

This publication has 0 references indexed in Scilit: