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Perioperative Guidelines for Elective Surgery in the Human Immunodeficiency Virus–Positive Patient

Davison, Steven P. D.D.S., M.D.; Reisman, Neil R. M.D., J.D.; Pellegrino, Edmund D. M.D.; Larson, Ethan E. M.D.; Dermody, Meghan M.D.; Hutchison, Paul J. M.A.

Plastic and Reconstructive Surgery: May 2008 - Volume 121 - Issue 5 - p 1831-1840
doi: 10.1097/PRS.0b013e31816b143b
Cosmetic: Special Topic

Background: Human immunodeficiency virus (HIV)–positive patients with changes in body morphology can be challenging for the plastic surgeon. Uncertainty about the advisability of elective procedures for these patients and fears of infection transmission may cause trepidation. Plastic surgeons are likely to encounter these patients in increasing numbers. The authors provide an overview of HIV lipodystrophy and treatment options. Clinical parameters are established that must be met before elective procedures on HIV-positive patients. In addition, ethical and legal considerations are discussed.

Methods: A literature review was conducted to identify articles reporting specific, identifiable factors influencing operative risk in HIV-positive patients. Legal and ethical experts were consulted.

Results: Specific risk factors influencing operative morbidity include an absolute CD4 count of less than 200 cells/cc3 or viral load greater than 10,000 copies/ml. Patients with CD4 counts greater than 200 cells/cc3 and a low viral load have a risk of postoperative complications similar to that of the general population and should therefore be evaluated on established preoperative parameters (e.g., American Society of Anesthesiologists class, nutrition, and age).

Conclusions: Patients with HIV-associated body morphology changes can be safely treated by the plastic surgeon, provided that a thorough preoperative workup is performed. There is minimal risk of disease transmission. There is an ethical and legal obligation to treat these patients if the patient is suitable and the procedure in question falls under the expertise of the consulting surgeon.

Washington, D.C.; and Houston, Texas

From the Department of Plastic Surgery and the Center for Clinical Bioethics, Georgetown University Medical Center, and the Department of Plastic Surgery, Baylor College of Medicine.

Received for publication March 13, 2007; accepted September 25, 2007.

Disclosure: None of the authors has any financial conflicts of interest to declare.

Steven P. Davison, D.D.S., M.D., Department of Plastic Surgery, Georgetown University Medical Center, 1st Floor PHC Building, 3800 Reservoir Road, N.W., Washington, D.C. 20007, spd2@georgetown.edu

©2008American Society of Plastic Surgeons