Foschi D, Cellerino P, Corsi F, Casali A, Rizzi A, Righi I, Trabucchi E
Department of S. Siro Clinical Institute, University of Milan, Milan, Italy.
Br J Surg. 2006 Nov;93(11):1383-9. doi: 10.1002/bjs.5527.
Highly active antiretroviral therapy (HAART) reduces virus proliferation and significantly decreases the rate of septic and opportunistic complications in patients infected with human immunodeficiency virus (HIV). Although surgery is performed routinely on patients receiving HAART, the effect of this treatment on surgical outcome has not been examined in detail.
This retrospective study reviewed 54 consecutive patients with HIV infection who underwent surgical cholecystectomy: 31 patients were on HAART, 13 on nucleoside analogue reverse transcriptase inhibitors (NRTIs) and ten were receiving no specific therapy. Characteristics of HIV-1 infection, laboratory investigations, characteristics of the gallbladder disease, type of operation, postoperative course, morbidity and mortality were recorded. Univariable analysis and unconditional logistic regression were performed to determine factors related to postoperative complications and death.
The three groups were similar in terms of HIV-1 infection characteristics. In univariable analysis HAART and laparoscopic cholecystectomy were associated with a significantly lower complication rate, whereas only HAART was shown to be protective by logistic regression analysis. A low HIV RNA load and a high CD4(+) cell count were significant predictors of uncomplicated surgical outcomes.
HAART significantly reduces the risk of complications after cholecystectomy in patients with HIV infection or acquired immune deficiency syndrome.
高效抗逆转录病毒疗法（HAART）可减少病毒增殖，并显著降低人类免疫缺陷病毒（HIV）感染者发生败血症和机会性并发症的几率。尽管接受HAART治疗的患者会常规进行手术，但该治疗对手术结果的影响尚未得到详细研究。
这项回顾性研究对54例连续接受外科胆囊切除术的HIV感染者进行了分析：31例患者接受HAART治疗，13例接受核苷类逆转录酶抑制剂（NRTIs）治疗，10例未接受任何特异性治疗。记录HIV-1感染的特征、实验室检查结果、胆囊疾病的特征、手术类型、术后病程、发病率和死亡率。进行单因素分析和无条件逻辑回归分析，以确定与术后并发症和死亡相关的因素。
三组在HIV-1感染特征方面相似。单因素分析显示，HAART治疗和腹腔镜胆囊切除术与较低的并发症发生率显著相关，而逻辑回归分析表明只有HAART具有保护作用。低HIV RNA载量和高CD4(+)细胞计数是手术结果无并发症的重要预测指标。
HAART可显著降低HIV感染或获得性免疫缺陷综合征患者胆囊切除术后的并发症风险。
