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The influence of major surgery on HIV disease progression and decline in CD4 + cell count was evaluated in 23 seropositive haemophilia patients. 24 HIV‐infected patients served as non‐operated controls. In addition, 32 age‐matched seronegative subjects were included. The follow‐up time was up to 5 years. During the course of the study, eight of the operated (35%) and 11 of the non‐operated (48%) subjects developed HIV‐related symptoms ( P = 0.267). The relative risk for developing HIV‐related symptoms after surgery was 0.60 (95% CI 0.25; 1.48). A significant decline in CD4 + cell counts was observed in both the surgery (4.0 × 10 6 /l/month, 95% CI 2.0; 6.0 × 10 6 , P = 0.001) and the non‐surgery (4.0 × 10 6 /l/month, 95% CI 2.0; 6.0 × 10 6 , P = 0.004) seropositive subgroup, but no difference between the two subgroups was seen ( P = 0.793). HIV (6.0 × 10 6 /l/month, 95% CI 2.1; 9.9 × 10 6 , P = 0.0005) but not surgery (−1.0 × 10 6 /l/month, 95% CI −3.0; 0.96 × 10 6 , P = 0.647) was an independent predictor for the decline in CD34 + cell count. No interaction effect was observed between HIV infection and surgery ( P = 0.361). The annual amount of factor concentrate used for regular replacement therapy did not influence the decline in CD4 + cell count ( P = 0.492). We conclude that major surgery may be considered in symptom‐free HIV‐seropositive haemophilia patients, with CD4 + cell counts 0.20 × 10 9 /l under similar premises as for seronegative subjects.
Astermark et al. (Thu,) studied this question.