Subscribe to RSS
Gender Reassignment Surgery in Human Immunodeficiency Virus-Positive Patients: A Report of Two CasesThis study was supported by research funds from Dong-A University.
It is believed that surgery on human immunodeficiency virus (HIV)-positive patients is dangerous and should be avoided due to the possibility of postoperative infection of the patients or HIV occupational transmission to the medical staff. We discuss here the preparations and measures needed to conduct surgery safely on HIV-positive patients, based on our experience. We performed sex reassignment surgery on two HIV-positive patients from January 2013 to January 2015. Both of them were receiving highly active antiretroviral therapy and were asymptomatic, with a normal CD4 count (>500 cells/µL). The HIV-RNA was undetectable within the bloodstream. All the staff wore protective clothing, glasses, and three pairs of protective gloves in the operating room because of the possibility of transmission. Prophylactic antibiotics were administered to the patients, and antiviral therapy was performed during their perioperative course. Neither of the patients had postoperative complications, and none of the medical staff experienced accidental exposure. Both patients had satisfactory surgery outcomes without complications. HIV-positive patients can undergo surgery safely without increased risk of postoperative complications or HIV transmission to the staff through the proper use of antibiotics, active antiretroviral therapy, and supplemental protective measures with post-exposure prophylaxis for the staff in case of HIV exposure.
This study was presented at the 4th Research & Reconstructive Forum on April 3-4, 2014 in Busan, Korea.
Received: 25 June 2015
Accepted: 07 September 2015
Article published online:
05 May 2022
© 2015. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Attia S, Egger M, Muller M. et al. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. Aids 2009; 23: 1397-1404
- 2 Palella Jr FJ, Delaney KM, Moorman AC. et al. HIV Outpatient Study Investigators. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection N Engl J Med 1998; 338: 853-860
- 3 Lane HC, Masur H, Edgar LC. et al. Abnormalities of B-cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome. N Engl J Med 1983; 309: 453-458
- 4 Leone S, Gregis G, Quinzan G. et al. Causes of death and risk factors among HIV-infected persons in the HAART era: analysis of a large urban cohort. Infection 2011; 39: 13-20
- 5 Shelburne SA, Visnegarwala F, Darcourt J. et al. Incidence and risk factors for immune reconstitution inflammatory syndrome during highly active antiretroviral therapy. AIDS 2005; 19: 399-406
- 6 Schnittman SM, Greenhouse JJ, Psallidopoulos MC. et al. Increasing viral burden in CD4+ T cells from patients with human immunodeficiency virus (HIV) infection reflects rapidly progressive immunosuppression and clinical disease. Ann Intern Med 1990; 113: 438-443
- 7 Seltzer DG, McAuliffe J, Campbell DR. et al. AIDS in the hand patient: the team approach. Hand Clin 1991; 7: 433-445
- 8 Modjarrad K, Chamot E, Vermund SH. Impact of small reductions in plasma HIV RNA levels on the risk of heterosexual transmission and disease progression. AIDS (London, England) 2008; 22: 2179-2185
- 9 Mayer KH, Mimiaga MJ, Gelman M. et al. Raltegravir, tenofovir DF, and emtricitabine for postexposure prophylaxis to prevent the sexual transmission of HIV: safety, tolerability, and adherence. J Acquir Immune Defic Syndr 2012; 59: 354-359
- 10 Henderson DK, Fahey BJ, Willy M. et al. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures: a prospective evaluation. Ann Intern Med 1990; 113: 740-746
- 11 Connor EM, Sperling RS, Gelber R. et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment: Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994; 331: 1173-1180
- 12 Cardo DM, Culver DH, Ciesielski CA. et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure: Centers for Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med 1997; 337: 1485-1490
- 13 Otten RA, Smith DK, Adams DR. et al. Efficacy of postexposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). J Virol 2000; 74: 9771-9775
- 14 Panlilio AL, Cardo DM, Grohskopf LA. et al. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for post-exposure prophylaxis. MMWR Recomm Rep 2005; 54: 1-17