CARDIOPULMONARY BYPASS IN HIV-POSITIVE PATIENTS

To prove the hypothesis that cardiopulmonary bypass may accelerate the development of acquired immunodeficiency syndrome (AIDS) in the human immunodeficiency virus carrier, the clinical course of 40 patients positive for human immunodeficiency virus who underwent cardiac operations between 1986 and 1992 was analyzed, especially in regard to the progression to AIDS. Mean age was 30 years (range, 19 to 61 years). Thirty-four patients (85%) were intravenous drug abusers; in 4 (10%) transmission of infection was sexual, and in 2 (5%) it was through a contaminated blood transfusion. Valve procedures were performed in 38 patients (95%), mostly for endocarditis in drug addicts. Hospital mortality was 20% (8 patients). The 32 survivors have been followed up a mean of 21 months (range, 4 months to 6 years). Four patients (12.5%) experienced progression to AIDS during the follow-up period. Actuarial progression to AIDS is 5% (+/-5%) at 1 year, 20% (+/-10%) at 2 years, and 40% (+/-19%) at 5 years. There have been 8 late deaths (5 due to recurrent endocarditis, 2 due to AIDS, and 1 due to overdose). Actuarial survival is 79% (+/-8%) at 1 year, 60% (+/-11%) at 2 years, and 48% (+/-14%) at 5 years. The results indicate that progression to AIDS in the patient positive for human immunodeficiency virus is not accelerated by the use of cardiopulmonary bypass. The poor prognosis in these patients is mainly related to the particular pathological conditions that often affect the drug addict population.