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Virologically controlled HIV with poor immune reconstitution - surgical risk?

  • 1.  Virologically controlled HIV with poor immune reconstitution - surgical risk?

    Posted 06-02-2022 15:25
    Hi,

    I know a number of studies in the past looked at risk of surgical complications in HIV patients, finding that those with CD4 <200 fared more poorly - but from what I can see, most did not control for viral loads. Is there good data showing evidence of increased surgical complications in those with longstanding controlled HIV, but poor immune reconstitution? I ask in particular because I care for trans patients, and some surgeons won't do gender affirming surgical procedures - of any kind - if the CD4 is <200. I would like to potentially challenge them on that, but I'd like some data to back me up, and I didn't find a whole lot when I looked. Anyone know of more recent data?

    Thanks.

    Jenny

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    Jennifer Aldrich
    Philadelphia PA
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  • 2.  RE: Virologically controlled HIV with poor immune reconstitution - surgical risk?

    Posted 25 days ago
    This is a patient-centric issue. Sure, in total low CD4 count correlates with risk of worse outcome but most of this is related to general health issues and can be recognized without a CD4 count. It can be summed up by the adage 'sicker people are sicker'.
     
    Its best to remember that chronic inflammation from many sources lowers CD4 percentages and also absolute levels. Smokers tend to have slightly higher baseline neutrophil counts and lower CD4 percentages. They also have higher surgical risk. Also Africans tend to have lower leukocyte counts at baseline than the Anglo cohorts used when CD4 risk stratification studies were done.
     
    Risk-benefit for surgical procedures is routinely regarded as patient-centric.
     
    David M. Bebinger, MD
     
     
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