Acute appendicitis in people living with HIV: What does the emergencysurgeon needs to know?

摘要

Acute appendicitis is among the commonest surgical emergencies seen in an acutesetting. Individuals living with the Human Immunodeficiency Virus (HIV) and/orthe Acquired Immunodeficiency Syndrome (AIDS) have an increased risk ofencountering complications with acute appendicitis. We conducted a literaturesearch using the words appendicitis and HIV in google scholar, Medline, Scopusand PubMed. The search also extended to cover HIV presented with acuteappendicitis, their outcome during and following the management of acuteappendicitis. Several studies showed that HIV is associated with a higher rateof acute appendicitis than the general population. HIV can directly affect theappendix, through opportunistic infections, immune reconstitution inflammatorysyndrome associated with start of antiretroviral medication. High index ofsuspicion is needed to exclude conditions that mimic acute appendicitis(abdominal tuberculosis, pyelonephritis, cytomegalovirus, cryptosporidium,pneumococcus, Amoebic appendicitis and pill impaction). The clinicalpresentation may not be typical of acute appendicitis and can be associated withlow white cell count and variable fever. The Alvarado score for predicting acuteappendicitis can be used and more research is needed to establish cut-off pointvalue. Computed tomography scan and ultrasound are widely used in clinicaldiagnosis. Importantly, acute appendicitis with HIV/AIDS can be associated withhigh rate of post-surgical complications like infections, delay of healing,perforation, peritonitis, intra-abdominal abscess and longer hospital stay.HIV/AIDS with acute appendicitis is complex condition. Therefore, we concludethat patients with known HIV and acute appendicitis should also be managed inclose liaison with HIV physicians during, before and after surgicaltreatment.