Peritonitis following hollow organ perforation: features in HIV-associated immunosuppression

Objective. To analyze etiology, clinical course, in-hospital mortality and treatment outcomes in patients with peritonitis following hollow organ perforation and HIV-associated immunosuppression, as well as to develop an optimal therapeutic and diagnostic algorithm improving prognosis in this patient group. Material and methods. A retrospective study of two groups of patients with peritonitis was conducted. The study group consisted of 83 patients with HIV infection, the comparison group — 504 patients without HIV. Standard diagnostic criteria for peritonitis, MPI index, histological, bacterioscopic, and molecular genetic examinations of specimens were used. In HIV-positive patients, immune status (CD4+ lymphocyte) was additionally analyzed. Statistical analysis was performed in R 4.4.0. Results. Comparative analysis revealed significant differences in groups. Patients with HIV were younger (median age 40 years vs. 49 years). The causes of perforations varied significantly. In HIV-negative patients, perforation of duodenal and gastric ulcers (63.5%), as well as perforations of tumors (25.6%) prevailed. In HIV-positive patients with severe immunodeficiency (CD4+ <200 cells/µl), the leading causes became tuberculous (76.8%) and cytomegalovirus (14.3%) intestinal ulcers. Mortality in the HIV group was significantly higher (20.5% vs. 1.8%) with all fatal outcomes among patients with CD4+ <200 cells/µl (mortality in this subgroup was 30.4%). Surgical approaches in patients with immunodeficiency more frequently included bowel resection with ileostomy, as well as required a greater number of redo surgeries. Conclusion. Patients with peritonitis following hollow organ perforation and HIV-associated immunodeficiency represent a special group differing in causes of perforation and extremely high risk of mortality. To improve treatment outcomes, we need for early diagnosis of immunosuppression, active searching for opportunistic infections, individual surgical strategies avoiding primary anastomoses in case of severe immunodeficiency, as well as multidisciplinary approach to patient management and early initiation of empirical therapy.