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The occurrence of AIDS-associated non-Hodgkin's lymphoma (AIDS-NHL) in hemophiliacs may be increasing in the later stages of AIDS diagnoses and may be linked with longer periods of immunosuppression. Of 33 HIV-infected hemophiliacs, those with NHL as their second AIDS-related disease were older and had lower CD4 counts following longer phases of immunosupression compared to those with NHL as their first AIDS-related disease. Antiretroviral therapy was responsible for an increase in survival rate as well as the prolonged immunosupression.

As part of a prospective cohort study initiated in 1983, the human immunodeficiency virus type 1 (HIV-1) status has been periodically determined for patients with clotting disorders (hemophilia A or B, von Willebrand's disease, miscellaneous). The University of North Carolina Hospitals has conducted comprehensive surveillance for nosocomial infections (NI) using modified Centers for Disease Control criteria since 1980 and entered this information in a computerized data base. Cross-matching of our NI data base and hemophiliac/HIV-1 study data base for the time period 1980-1989 revealed that 13 NI occurred in 11 patients during 659 hospitalizations (5,723 hospital days). NI rates per 100 admissions (per 1,000 hospital days) by HIV-1 status were as follows: HIV-1 negative - 0.91 (1.18), HIV-1 positive pre-AIDS = 1.65 (1.84), and AIDS = 6.67 (6.48). NI occurred with a similar frequency in HIV-1 positive pre-AIDS hemophiliacs and HIV-1 negative hemophiliacs (Fisher's exact test, p >0.10). However, NI occurred more frequently in hemophiliacs with AIDS versus HIV-1 positive or negative hemophiliacs (Fisher's exact test, p, A nosocomial infection (NI) is one that a patient acquires while in the hospital. Studies have shown that hospitalized patients with severe illnesses have a high risk of developing NIs. Also, it is well known that patients with AIDS are at risk for developing life-threatening infections. It is estimated that 35 to 70 percent of the people who have hemophilia (a disease in which the blood does not clot properly) test positive for the human immunodeficiency virus type 1 (HIV-1, the virus that causes AIDS). Therefore, a study was performed to determine the prevalence of NIs in hemophiliacs with and without HIV-1 infections. The study included 195 patients with hemophilia. Of these patients, 24 had AIDS, 104 had HIV-1 infections but had not developed symptoms of AIDS (HIV-positive), and 67 did not have an infection with HIV-1 (HIV-negative). The AIDS patients spent a longer time in the hospital (10.3 days) than those who were HIV-positive (9.0 days) or HIV-negative (7.7 days). During the study period, 11 patients got a total of 13 NIs. Blood and urinary tract infections were the most common types of infections. Of the 11 patients who developed NIs, four had AIDS, five were HIV-positive, and two were HIV-negative. These results translate to a NI rate of one out of every 15 hemophiliacs with AIDS, one out of every 61 who are HIV-positive, and one out of every 110 who are HIV-negative. Factors that increased the risk of NI in patients with AIDS included treatment with antibiotics and the use of central intravenous catheters. It is concluded that full-blown AIDS increases the risk of developing NIs, but HIV-1 infections that have not progressed to AIDS do not significantly increase the risk of NI. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients who test positive for the human immunodeficiency virus and have gone on to develop either acquired immune deficiency syndrome (AIDS) or AIDS-related complex (ARC) are known to have a high incidence of bacterial infections. It is not known if patients who are HIV-positive but have not developed ARC or AIDS are also at increased risk of infection. It is estimated that there are about 1.5 million such people in the United States. There is concern about the risks involved in operating on these asymptomatic patients, because many have decreased immune function at a subclinical level, i.e. detectable only with laboratory or other testing. A study was undertaken to compare the operative risks of two groups of hemophiliacs, one group HIV-positive and the other HIV-negative. A retrospective review identified 102 hemophiliac patients who had undergone surgery; these patients were cross-referenced to patients in an ongoing study of hemophiliac patients who are HIV-positive. This cross-referencing revealed 83 patients with known HIV status who had undergone 169 operations. These patients were grouped according to HIV-positive status, HIV-negative status, or unclear HIV status (those patients who had surgery before their HIV status had been established). The wound infection rates of the three groups were: HIV-positive, 1.4 percent; unclear HIV status 1.5 percent; HIV-negative 0 percent. There was no significant difference in wound infection rates. It is concluded that surgery in HIV-positive, non-AIDS patients, does not carry an increased risk of wound infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patients who later go on to develop acquired immunodeficiency syndrome (AIDS) may harbor the human immunodeficiency virus (HIV) in their blood for several years. Hemophilia has been associated with AIDS since 1984; many hemophiliacs were infected by HIV via blood transfusions before the blood supply was screened for this virus. The effect of the compromise of the immune system caused by HIV infection on the outcome of surgery is not known. This is important in the case of hemophiliacs since patients with severe hemophilia frequently have serious joint disorders and need to undergo orthopedic surgery. In this study, hemophiliac patients who were HIV-positive were evaluated regarding the results of their operations. There were 26 operative procedures performed on these patients; only one patient developed infection, however five patients had abnormal temperature elevation following surgery. Their increased temperatures occurred without the expected elevation in white blood cell count. The patients who experienced fever had significantly reduced numbers of CD4 lymphocytes, a type of white blood cell, before surgery. In most cases the HIV infection progressed, with six patients being diagnosed with AIDS. Those patients who had low preoperative CD4 counts appeared to progress more rapidly to AIDS. It should be noted that these values typically vary for the same patient and they should be used only as a guideline. Skin antigens also give an evaluation of CD4 lymphocyte function. The authors suggest that evaluation by CD4 lymphocyte count and skin antigen testing be done to assess immune function prior to elective surgery in HIV-positive patients. Knowledge of how well the immune system is functioning can help predict the risk of infection after surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)