Accelerating HIV Infection with Cardiopulmonary Bypass—Case Reports

Abstract

Five men patients and 1 woman patient who underwent either coronary artery bypass grafting (in 2) or valve replacement (in 3) or combined procedures (in 1) presented with severe HIV infection during the postoperative period. Four patients were NYHA Class III of IV with 3 patients in extremis requiring emergency procedures. All procedures were performed with cardiopulmonary bypass with mean time of 109 ± 48 minutes and aortic cross-clamp of 52 ± 49 minutes. Although the immediate postoperative courses seemed benign or uncomplicated, all presented with severe infections during the late postoperative period following their procedures (twenty-one to ninety days). The opportunistic infections were Pneumocystis carinii pneumonia (2), toxoplasmosis in the central nervous system and lung (1), cryptococcal meningitis (1), Staphylococcus aureus endocarditis (1), and viral encephalitis (1). Three died with two months of surgery.

These complicated postoperative infections have raised the question of the safety of cardiopulmonary bypass in HIV-infected patients. Rational recommendations regarding preoperative HIV antibody testing, operative indications, and postoperative surveillance are offered.