Impact of an unknown HIV serostatus on the risk of postoperative cardiovascular morbidity and mortality

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Yoshan Moodley


HIV, AIDS Serodiagnosis, Surgery, Postoperative Complications, Myocardial Infarction, Stroke, Mortality


Background: An unknown HIV serostatus is associated with undesirable patient outcomes in medically-treated patients. The impact of an unknown HIV serostatus on postoperative outcomes, such as major adverse cardiovascular events (MACE), in surgical settings with a high prevalence of HIV infection has not yet been established. This was the impetus for the current study.
Methods: This was an unmatched case-control study of 460 (Patients with MACE/Cases = 92 and patients without MACE/Controls = 368) patients who underwent vascular/general surgery at a tertiary South African hospital. Data related to age, gender, and the presence of established cardiovascular risk factors in surgical settings were extracted from patient medical records. HIV serostatus for each patient was recorded as positive or negative (where preoperative documentation of such test results existed) or unknown (where no preoperative documentation of an HIV test result existed). Data were analyzed in accordance with recommendations for unmatched case-control study designs.

Results: Adjusted analysis revealed that there was no statistically significant difference in risk of postoperative MACE between HIV-negative (reference group), HIV-positive (Odds Ratio: 1.16, 95% Confidence Interval: 0.42-3.21) and HIV-unknown serostatus (Odds Ratio: 0.85, 95% Confidence Interval: 0.47-1.54) groups.

Conclusion: Our study findings suggest that an unknown HIV serostatus is not a risk factor for postoperative MACE. HIV serostatus should not be included in cardiovascular risk stratification methods in surgical settings with a high prevalence of HIV.