The scope and spectrum of challenges presented to the general surgeon by patients affected with the human immunodeficiency virus (HIV) : a review.
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Date
2012
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Abstract
Background: Surgical disease related to HIV is scantily documented with a paucity of data
detailing the manifestations of HIV in surgery especially in resource-poor, high prevalence
settings such as in South Africa. This review provides an update on the topical issues
surrounding HIV and surgery.
Objectives: The objective of the study was to determine the incidence, pathogenesis, clinical
presentation, aspects of diagnosis and management of: HIV- associated salivary gland disease
in particular parotid gland enlargement; Kaposi’s sarcoma (KS) and lower limb
lymphoedema; AIDS- related abdominal malignancies due to KS and lymphoma; Acalculous
cholecystitis and HIV- cholangiopathy and HIV- associated vasculopathy.
Methods: A collective review of the literature was performed and data sourced from a search
of relevant electronic medical databases for literature from the period 2000 to the present
date. Studies under each section were selected based on inclusion and exclusion criteria.
Content analysis was used to analyse data.
Results: The HIV pandemic has resulted in an increased frequency of benign
lymphoepithelial cysts making it the commonest cause of parotidomegaly in most surgical
practices. KS should be considered in the differential diagnosis of a patient with chronic
lymphoedema. Lymphoedema may be present without cutaneous lesions, making clinical
diagnosis of KS difficult. The gastrointestinal tract is the commonest site of extra- cutaneous
KS. Surgical management of the lymphoma patient is restricted nowadays to determining the
diagnosis and in some cases to evaluate disease stage. Highly active antiretroviral therapy
(HAART) is an important part of the management of biliary tract conditions in addition to
relevant surgical procedures. HIV- vasculopathy represents a distinct clinico- pathological
entity characterized by a vasculitis with probable immune- mediated or direct HIV- related
injury to the vessel wall.
Conclusion: The rising incidence of HIV in South Africa and other developing countries has
been associated with new and unusual disease manifestations requiring surgical management
for diagnostic, palliative or curative intent. It is crucial that surgeons remain abreast of new
developments related to the challenging spectrum of HIV and its protean manifestations.
Description
Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2012.
Keywords
HIV infections., Kaposi's sarcoma., AIDS (Disease)--South Africa., Theses--General surgery.