Infective complications after minor operations in patients infected with HIV: role of CD4 lymphocytes in prognosis.

OBJECTIVE

To find out the incidence of wound infection in patients with HIV and reduced counts of CD4 lymphocytes.

DESIGN

Open study.

SETTING

University hospital, Spain.

SUBJECTS

70 patients with HIV infection and enlarged lymph nodes.

INTERVENTIONS

Biopsy of lymph nodes and withdrawal of a sample of blood for counts of CD4 lymphocytes and neutrophils.

MAIN OUTCOME MEASURE

Development of infection at the biopsy site, and correlation of infecting organism with culture taken at the time of biopsy.

RESULTS

Patients were divided into three groups depending on their CD4 count: more than 500 cells/ml (n = 26), 200-500 cells/ml (n = 24), and less than 200 cells/ml (n = 20). Their neutrophil counts were 5.1, 3.8, and 2.5 x 10(9)/1, respectively. There were found four wound infections (6%); 2 were in the group with more than 500 CD4 cells/ml, and these were caused by Staphylococcus aureus (which had been grown from nodes in 6 patients at the time of biopsy). The other 2 were in the group with less than 500 cells/ml and these were caused by Mycobacterium tuberculosis; cultures of the nodes had shown Staphylococcus epidermidis (n = 3) and M tuberculosis (n = 17). There were no infections in the group with 200-500 CD4 cells/ml, in which S epidermidis (n = 5) and M tuberculosis (n = 8) had been cultured from the lymph nodes.

CONCLUSIONS

The CD4 count was of no prognostic importance in the development of wound infection, but severe depression of the CD4 count may increase the risk of atypical wound infections.