Acute systemic inflammatory response after cardiac surgery in patients infected with  human immunodeficiency virus using clinical and inflammatory markers.

Mawande KE Gojo1 , Rosaley Prakaschandra
1. Port Elizabeth Hospital Complex, Department of Cardiothoracic Surgery, Buckingham Road, Port Elizabeth,
South Africa. Gojomawande@yahoo.com
2. Durban University of Technology, Department of Biomedical and Clinical Technology; 41/43 ML Sultan Road,
Durban, South Africa. Rosaleypra@dut.ac.za .

Abstract
Background:Immediate post-cardiopulmonary bypass (CPB) immune responses and organ injuries in immune-compromised patients remain poorly documented.

Method: Sixty-one consecutive patients (30 HIV seropositive and 31 seronegative), undergoing elective cardiac  valve(s) replacement were enrolled, from a single center hospital, after informed consent was obtained. C-reactive  protein (CRP) and Erythrocyte sedimentation rate (ESR) were used as biomarkers of acute inflammatory response.

Results: The mean age was similar between the HIV seropositive and negative group. Pre-operatively, CRP (p=0.388)  and ESR (p=0.817) were comparable. The CPB events and durations were significantly different between the two  groups: duration (p=0.021), clamp aortic duration (p=0.026), bloodtransfusion (p=0.013), total urine output (p=0.035)  and peak lactate (p=0.040). Post-operatively, there was significant increased biomarkers level in both groups, albeit not  between the groups with a significant negative correlation between the mean change in CRP levels and mechanical  ventilation (r=0.548, p=0.002) in the seropositive group (r=0.025, p=0.893). The correlation between pre-operative  and post-operative difference in CRP and ICU stay was not significant in both groups. A significant drop (p=<0.001) in CD4 cells was documented post-operatively in the HIV seropositive group.

Conclusion:HIV positive patients’ post-operative reactions to cardiac surgery supported by CPB are similar to those  of HIV seronegative patients.

Keywords: Cardiopulmonary bypass (CPB), Human immunodeficiency virus (HIV), inflammation.