Appendicitis in the HIV Era: A South African perspective

The relationship between HIV infection and the clinical spectrum of appendicitis has not been fully elucidated in the South African context. The aim of this study is to compare the surgical management, histopathology, and outcomes between HIV-positive and HIV-negative patients undergoing surgery for appendicitis. A retrospective chart analysis was performed of 50 patients who underwent surgery for appendicitis at King Edward VIII Hospital, Durban, South Africa between January 2012 and December 2012. Patients were stratified by HIV serostatus into HIV-positive and HIV-negative groups. Fifty patients underwent surgery for appendicitis during the study period. Of the 50 patients, 14 were HIV-positive (28 %) and 36 were HIV-negative (72 %). Perforated appendicitis was more frequent in the HIV-positive group (50 vs. 25 %, p > 0.05). There was a significantly higher laparotomy rate in HIV-positive patients (71 vs. 33 %, p < 0.05). Granulomatous inflammation of the appendix was only noted in HIV-positive patients (n =3). There was no significant difference in the complication rate between the two groups (p > 0.05) and no difference in the mean length of hospital stay (7.8 ± 4.89 vs. 5.8 ± 3.94 days, p > 0.05). In this retrospective study, perforated appendicitis was seen to be more common in HIV-positive patients resulting in a higher laparotomy rate in this group. Granulomatous inflammation was only found in HIV-positive patients. There was no difference seen in the complication rate, length of hospital stay, and mortality between HIV-positive and HIV-negative patients.