Mahmood Arshad, Raza Syed H, Elshaikh Elamin, Mital Dushyant, Ahmed Mohamed H
Department of Colorectal/General Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK.
Department of General Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK.
SAGE Open Med. 2021 Jan 28;9:2050312120982461. doi: 10.1177/2050312120982461. eCollection 2021.
Acute appendicitis is among the commonest surgical emergencies seen in an acute setting. Individuals living with the Human Immunodeficiency Virus (HIV) and/or the Acquired Immunodeficiency Syndrome (AIDS) have an increased risk of encountering complications with acute appendicitis. We conducted a literature search using the words appendicitis and HIV in google scholar, Medline, Scopus and PubMed. The search also extended to cover HIV presented with acute appendicitis, their outcome during and following the management of acute appendicitis. Several studies showed that HIV is associated with a higher rate of acute appendicitis than the general population. HIV can directly affect the appendix, through opportunistic infections, immune reconstitution inflammatory syndrome associated with start of antiretroviral medication. High index of suspicion is needed to exclude conditions that mimic acute appendicitis (abdominal tuberculosis, pyelonephritis, cytomegalovirus, cryptosporidium, pneumococcus, Amoebic appendicitis and pill impaction). The clinical presentation may not be typical of acute appendicitis and can be associated with low white cell count and variable fever. The Alvarado score for predicting acute appendicitis can be used and more research is needed to establish cut-off point value. Computed tomography scan and ultrasound are widely used in clinical diagnosis. Importantly, acute appendicitis with HIV/AIDS can be associated with high rate of post-surgical complications like infections, delay of healing, perforation, peritonitis, intra-abdominal abscess and longer hospital stay. HIV/AIDS with acute appendicitis is complex condition. Therefore, we conclude that patients with known HIV and acute appendicitis should also be managed in close liaison with HIV physicians during, before and after surgical treatment.
急性阑尾炎是急性情况下最常见的外科急症之一。感染人类免疫缺陷病毒（HIV）和/或获得性免疫缺陷综合征（AIDS）的个体患急性阑尾炎并发症的风险增加。我们在谷歌学术、医学在线数据库（Medline）、Scopus和PubMed中使用“阑尾炎”和“HIV”进行了文献检索。检索还扩展到涵盖患有急性阑尾炎的HIV患者、他们在急性阑尾炎治疗期间及之后的结果。多项研究表明，与普通人群相比，HIV感染者患急性阑尾炎的比例更高。HIV可通过机会性感染、与开始抗逆转录病毒药物治疗相关的免疫重建炎症综合征直接影响阑尾。需要高度怀疑以排除疑似急性阑尾炎的疾病（腹部结核、肾盂肾炎、巨细胞病毒、隐孢子虫、肺炎球菌、阿米巴性阑尾炎和药丸嵌塞）。临床表现可能并非典型的急性阑尾炎，可能伴有白细胞计数低和发热程度不一。可使用预测急性阑尾炎的阿尔瓦拉多评分，还需要更多研究来确定截断点值。计算机断层扫描和超声在临床诊断中广泛应用。重要的是，患有HIV/AIDS的急性阑尾炎可能与术后高并发症发生率相关，如感染、愈合延迟、穿孔、腹膜炎、腹腔内脓肿和住院时间延长。HIV/AIDS合并急性阑尾炎是一种复杂的病症。因此，我们得出结论，已知患有HIV且患急性阑尾炎的患者在手术治疗期间、之前和之后也应与HIV专科医生密切协作进行管理。
