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Surgical Implications of Human Immunodeficiency Virus Infection in Children

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Pediatric Surgery

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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 (330,000 cases) 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, with current HAART (Highly Active Anti-retroviral Therapy) prognosis is, in the short term, excellent.

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References

  • Abuzaitoun OR, Hanson IC. Organ-specific manifestations of HIV disease in children. Pediatr Clin N Am. 2000;47(1):109–25.

    Article  CAS  Google Scholar 

  • Alexander A, Rode H. Adverse reactions to the Bacillus Calmette-Guerin vaccine in HIV-positive infants. J PediatrSurg. 2007;42(3):549–52.

    Google Scholar 

  • Balderas V, Spechler SJ. Upper gastrointestinal bleeding in a patient with AIDS. Nat Clin Pract Gastroenterol Hepatol. 2006;3(6):349–53. quiz following 353

    Article  PubMed  Google Scholar 

  • Banieghbal B. Minimally invasive surgery for children with HIV/AIDS. J Laparoendosc Adv Surg Tech A. 2009;19(1):97–101.

    Article  PubMed  Google Scholar 

  • Banieghbal B, Fonseca J. Acquired rectovaginal fistulae in South Africa. Arch Dis Child. 1997;77(1):94.

    Article  CAS  PubMed  Google Scholar 

  • Beaver BL, Hill JL, Vachon DA, Moore VL, Hines SE, Seiden SW, et al. Surgical intervention in children with human immunodeficiency virus infection. J PediatrSurg. 1990;25(1):79–82. discussion 82-4

    CAS  Google Scholar 

  • Biggar RJ, Frisch M, Goedert JJ. Risk of cancer in children with AIDS. AIDS-cancer match registry study group. JAMA. 2000;284(2):205–9.

    Article  CAS  PubMed  Google Scholar 

  • Bosenberg AT. Pediatricanesthesia in developing countries. Curr Opin Anaesthesiol. 2007;20(3):204–10.

    Article  PubMed  Google Scholar 

  • Bowley DM, Rogers TN, Meyers T, Pitcher G. Surgeons are failing to recognize children with HIV infection. J Pediatr Surg. 2007;42(2):431–4.

    Article  PubMed  Google Scholar 

  • Cairncross LL, Davidson A, Millar AJ, Pillay K. Kaposi sarcoma in children with HIV: a clinical series from red cross Children’s hospital. J PediatrSurg. 2009;44(2):373–6.

    Google Scholar 

  • Calis JC, van Hensbroek MB, de Haan RJ, Moons P, Brabin BJ, Bates I. HIV-associated anemia in children: a systematic review from a global perspective. AIDS. 2008;22(10):1099–112.

    Article  PubMed  Google Scholar 

  • Caselli D, Klersy C, de Martino M, Gabiano C, Galli L, Tovo PA, et al. Human immunodeficiency virus-related cancer in children: incidence and treatment outcome – report of the Italian Register. J Clin Oncol. 2000;18(22):3854–61.

    Article  CAS  PubMed  Google Scholar 

  • Cooke ML, Goddard EA, Brown RA. Endoscopy findings in HIV-infected children from sub-Saharan Africa. J Trop Pediatr. 2009;55(4):238–43.

    Article  CAS  PubMed  Google Scholar 

  • Cotton MF, Rabie H. Impact of earlier combination antiretroviral therapy on outcomes in children. Curr Opin HIV AIDS. 2015;10(1):12–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Desfrere L, de Oliveira I, Goffinet F, El Ayoubi M, Firtion G, Bavoux F, et al. Increased incidence of necrotizing enterocolitis in premature infants born to HIV-positive mothers. AIDS. 2005;19(14):1487–93.

    Article  PubMed  Google Scholar 

  • Eley BS, Sive AA, Shuttleworth M, Hussey GD. A prospective, cross-sectional study of anaemia and peripheral iron status in antiretroviral naive, HIV-1 infected children in Cape Town, South Africa. BMC Infect Dis. 2002;2:3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fantry L. Gastrointestinal infections in the immunocompromised host. Curr Opin Gastroenterol. 2003;19(1):37–41.

    Article  CAS  PubMed  Google Scholar 

  • Flores G, Stavola JJ, Noel GJ. Bacteremia due to Pseudomonas aeruginosa in children with AIDS. Clin Infect Dis. 1993;16(5):706–8.

    Article  CAS  PubMed  Google Scholar 

  • George R, Andronikou S, Theron S, du Plessis J, Hayes M, Goussard P, et al. Pulmonary infections in HIV-positive children. Pediatr Radiol. 2009;39(6):545–54.

    Article  PubMed  Google Scholar 

  • Hadley GP, Naude F. Malignant solid tumour, HIV infection and tuberculosis in children: an unholy triad. Pediatr Surg Int. 2009;25(8):697–701.

    Article  CAS  PubMed  Google Scholar 

  • Horberg MA, Hurley LB, Klein DB, Follansbee SE, Quesenberry C, Flamm JA, et al. Surgical outcomes in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy. Arch Surg. 2006;141(12):1238–45.

    Article  PubMed  Google Scholar 

  • Issa RA, Podbielski FJ, Fontaine JP, Connolly AE, Walsh WV, Fraire AE. Esophagectomy in a patient with AIDS. Dis Esophagus. 2004;17(3):270–2.

    Article  CAS  PubMed  Google Scholar 

  • Johnson PJ, Mirzai TH, Bentz ML. Carbon dioxide laser ablation of anogenital condyloma acuminata in pediatric patients. Ann Plast Surg. 1997;39(6):578–82.

    Article  CAS  PubMed  Google Scholar 

  • Johnson G, Levison J, Malek J. Should providers discuss breastfeeding with women living with HIV in high-income countries? An ethical analysis. Clin Infect Dis. 2016;63(10):1368–72.

    Article  PubMed  Google Scholar 

  • Kahn E. Gastrointestinal manifestations in pediatric AIDS. Pediatr Pathol Lab Med. 1997;17(2):171–208.

    CAS  PubMed  Google Scholar 

  • Karpelowsky J, Millar AJ. Surgical implications of human immunodeficiency virus infections. Semin Pediatr Surg. 2012;21(2):125–35.

    Article  PubMed  Google Scholar 

  • Karpelowsky J, Leva E, Kelley B, Numanoglu A, Rode H, Millar A. Outcomes of human immunodeficiency virus-infected and -exposed children undergoing surgery-a prospective study. J Pediatr Surg. 2009;44(4):681–7.

    Article  PubMed  Google Scholar 

  • Karpelowsky JS, van Mil S, Numanoglu A, Leva E, Millar AJ. Effect of maternal human immunodeficiency virus status on the outcome of neonates with necrotizing enterocolitis. J Pediatr Surg. 2010;45(2):315–8. discussion 318

    Article  PubMed  Google Scholar 

  • Karpelowsky JS, Millar AJ, van der Graaf N, van Bogerijen G, Zar HJ. Outcome of HIV-exposed uninfected children undergoing surgery. BMC Pediatr. 2011a;11:69-2431-11-69.

    Article  Google Scholar 

  • Karpelowsky JS, Zar HJ, van Bogerijen G, van der Graaf N, Millar AJ. Predictors of postoperative complications in HIV-infected children undergoing surgery. J PediatrSurg. 2011b;46(4):674–8.

    Google Scholar 

  • Karpelowsky JS, Millar AJ, van der Graaf N, van Bogerijen G, Zar HJ. Comparison of in-hospital morbidity and mortality in HIV-infected and uninfected children after surgery. Pediatr Surg Int. 2012;28(10):1007–14.

    Article  PubMed  Google Scholar 

  • Kleinhaus S, Weinberg G, Sheran M, Boley SJ. The management of surgery in infants and children with the acquired immune deficiency syndrome. J Pediatr Surg. 1985;20(5):497–8.

    Article  CAS  PubMed  Google Scholar 

  • Leelanukrom R, Pancharoen C. Anesthesia in HIV-infected children. Paediatr Anaesth. 2007;17(6):509–19.

    Article  PubMed  Google Scholar 

  • Lord RV. Anorectal surgery in patients infected with human immunodeficiency virus: factors associated with delayed wound healing. Ann Surg. 1997;226(1):92–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Madiba TE, Muckart DJ, Thomson SR. Human immunodeficiency disease: how should it affect surgical decision making? World J Surg. 2009;33(5):899–909.

    Article  CAS  PubMed  Google Scholar 

  • Mattioli G, Avanzini S, Pini-Prato A, Buffa P, Guida E, Rapuzzi G, et al. Risk management in pediatric surgery. Pediatr Surg Int. 2009;25(8):683–90.

    Article  PubMed  Google Scholar 

  • Nelson L, Fried M, Stewart K. HIV-infected patients: the risks of surgery. J Perioper Pract. 2009;19(1):24–30.

    PubMed  Google Scholar 

  • Pijnenburg MW, Cotton MF. Necrotising fasciitis in an HIV-1-infected infant. S Afr Med J. 2001;91(6):500–1.

    CAS  PubMed  Google Scholar 

  • Prose NS. Cutaneous manifestations of HIV infection in children. Dermatol Clin. 1991;9(3):543–50.

    CAS  PubMed  Google Scholar 

  • Prose NS. Cutaneous manifestations of pediatric HIV infection. PediatrDermatol. 1992;9(4):326–8.

    CAS  Google Scholar 

  • Puthanakit T, Oberdorfer P, Ukarapol N, Akarathum N, Punjaisee S, Sirisanthana T, et al. Immune reconstitution syndrome from nontuberculous mycobacterial infection after initiation of antiretroviral therapy in children with HIV infection. Pediatr Infect Dis J. 2006;25(7):645–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Roider JM, Muenchhoff M, Goulder PJ. Immune activation and paediatric HIV-1 disease outcome. Curr Opin HIV AIDS. 2016;11(2):146–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Shelburne SA, Visnegarwala F, Darcourt J, Graviss EA, Giordano TP, White Jr AC, et al. Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS. 2005;19(4):399–406.

    Article  PubMed  Google Scholar 

  • Slogrove AL, Cotton MF, Esser MM. Severe infections in HIV-exposed uninfected infants: clinical evidence of immunodeficiency. J Trop Pediatr. 2010;56(2):75–81.

    Article  CAS  PubMed  Google Scholar 

  • Stefan DC. Effect of HIV infection on the outcome of cancer therapy in children. Lancet Oncol. 2014;15(12):e562-7.

    Article  PubMed  Google Scholar 

  • Stefan DC, Wessels G, Poole J, Wainwright L, Stones D, Johnston WT, et al. Infection with human immunodeficiency virus-1 (HIV) among children with cancer in South Africa. Pediatr Blood Cancer. 2011;56(1):77–9.

    Article  PubMed  Google Scholar 

  • Stefanaki C, Stratigos AJ, Stratigos JD. Skin manifestations of HIV-1 infection in children. Clin Dermatol. 2002;20(1):74–86.

    Article  PubMed  Google Scholar 

  • Tran HS, Moncure M, Tarnoff M, Goodman M, Puc MM, Kroon D, et al. Predictors of operative outcome in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Am J Surg. 2000;180(3):228–33.

    Article  CAS  PubMed  Google Scholar 

  • UNAIDS_Global_Report_2012_en.pdf. Accessed 19 Feb 2013

    Google Scholar 

  • Violari A, Cotton MF, Gibb DM, et al. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008;359:2233–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wiersma R. HIV-positive African children with rectal fistulae. J Pediatr Surg. 2003;38(1):62–4. discussion 62-4

    Article  CAS  PubMed  Google Scholar 

  • Yii MK, Saunder A, Scott DF. Abdominal surgery in HIV/AIDS patients: indications, operative management, pathology and outcome. Aust N Z J Surg. 1995;65(5):320–6.

    Article  CAS  PubMed  Google Scholar 

  • Zanolla G, Resener T, Knebel R, Verney Y. Massive lower gastrointestinal hemorrhage caused by CMV disease as a presentation of HIV in an infant. Pediatr Surg Int. 2001;17(1):65–7.

    Article  CAS  PubMed  Google Scholar 

  • Zar HJ. Pneumonia in HIV-infected and HIV-uninfected children in developing countries: epidemiology, clinical features, and management. Curr Opin Pulm Med. 2004;10(3):176–82.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Emeritus Professor of Paediatric Surgery, Faculty of Health Sciences, Department of Paediatric Surgery, University of Cape Town, 7700Western Cape Province, Cape Town, Rondebosch, South Africa

    Alastair J. W. Millar

  2. Faculty of Health Sciences, Red Cross Children’s Hospital, University of Cape Town, 7700Western Cape Province, Cape Town, Rondebosch, South Africa

    Alastair J. W. Millar

  3. Senior Lecturer, Paediatric Surgeon, Paediatric Oncology and Thoracic Surgery, Children’s Hospital at Westmead Children’s cancer research Unit, University of Sydney, Sydney, Australia

    Jonathan Karpelowsky

  4. Associate Professor, Faculty of Health Sciences, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa

    Sharon Cox

Authors
  1. Alastair J. W. Millar
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  2. Jonathan Karpelowsky
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  3. Sharon Cox
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Correspondence to Alastair J. W. Millar .

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Editors and Affiliations

  1. Our Lady’s Children's Hospital, National Children’s Research Centre, Dublin, Ireland

    Prem Puri

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Millar, A.J.W., Karpelowsky, J., Cox, S. (2016). Surgical Implications of Human Immunodeficiency Virus Infection in Children. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_41-1

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  • DOI: https://doi.org/10.1007/978-3-642-38482-0_41-1

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  • Print ISBN: 978-3-642-38482-0

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