Surgical Implications of Human Immunodeficiency Virus Infection in Children

Abstract

According to the joint United Nations Program on HIV/AIDS (UNAIDS), 34 million people worldwide were estimated to be living with HIV or acquired immune deficiency syndrome (AIDS) at the end of 2011 (UNAIDS_ Global_Report_2012_en.pdf. Accessed 19 Feb 2013). Most reside in the developing world, with approximately two-thirds in sub-Saharan Africa. The annual rate of incident (new) HIV infections is believed to have peaked at >3 million in the late 1990s and was 2.5 million in 2011 (UNAIDS_ Global_Report_2012_en.pdf. Accessed 19 Feb 2013; Karpelowsky J, Millar AJ Semin Pediatr Surg 21(2):125–135, 2012). Approximately 12 percent of these infections (330,000cases) occurred in children younger than 15 years of age (UNAIDS_Global_Report_2012_en.pdf. Accessed 19 Feb 2013). Thus pediatric HIV infection is a pandemic affecting children predominantly in sub-Saharan Africa but is also seen in Asia and sporadically elsewhere (UNAIDS_Global_Report_2012_en.pdf. Accessed 19 Feb 2013). The number of children newly infected with HIV has decreased dramatically. This decrease is a consequence of the success of interventions to prevent mother-to-child transmission (PMTCT) of HIV. These interventions include early identification of HIV infection in pregnant women through routine antenatal testing, provision of antiretroviral medications to the pregnant woman and her infant, delivery by elective Caesarean section when indicated and the complete avoidance of breastfeeding. In addition the widespread availability of educational programs addressing HIV infection, prevention of HIV perinatal transmission and HIV counselling and testing services have further reduced the incidence. HIV infected children may require surgery either as an emergency to deal with a life threatening condition or a complication of the disease, non-emergency procedures where surgery is required to assist is the diagnosis of an HIV related condition or for elective surgery for routine childhood procedures. Surgical problems associated with HIV infection are described under categories of soft tissue or organ specific infections requiring drainage or debridement, gastrointestinal tract disease and complications, infections in the perineal area, and malignancies. Although surgical outcomes are compromised in children with AIDS, current HAART (Highly Active Anti-retroviral Therapy) prognosis is, in the short term, excellent.