Question
Can I have surgery if I have just started treatment?
4 January 2023. Related: All topics, CD4 and viral load, Opportunistic infections.
I, 51 year-old male, was diagnosed with HIV in September 2022, starting CD4 of 159. I have been on TLD since.
In November I visited an ENT for breathing issues, CT scan and nasal endoscopy showed an inverted papilloma that is a tumor in my right sinus, under the cheek, adjoining the right nostril.
On youtube, Inverted papilloma is described as a benign tumor, but in 15 percent of cases has been linked to squamous cell cancer.
ENT advised me for FESS (Functional endoscopic sinus surgery) for removal and biopsy.
My question is with such a low CD4 count that is in AIDS range, is it a risk to undergo surgery and any subsequent infections or
should I wait for some time say 3 to 6 months, see if my cd4 has increased, and then have the surgery.
I’m in South Asia where even medical staff harbor prejudices against HIV people.
My ENT doesn’t yet know that I have HIV, but will obviously know before surgery when they run a blood test to check for HIV.
Answer
Hi, how are you doing?
No. You do not need to wait. CD4 count recovers slowly and waiting 3-6 months is not likely to have a significant increase on your CD4 count. Your viral load is now likely undetectable as ART can suppress this quickly soon after starting, but CD4 recovers naturally and this can take years. As your CD4 count is below 200 are you taking any other medication? Usually you are given an antibiotic called co-trimoxazole (Bactrim/Septrin) to prevent against other infections while your immune system recovers.
The surgery that has been recommended is not a very invasive procedure with a very low complication rate. These complications will be discussed with your surgeon prior to you agreeing to the surgery. As you have already started treatment there is no need to postpone the surgery. In most cases there is no difference in outcome between people in early HIV infection and HIV negative individuals.
There are scores that along with HIV, your surgeon will calculate to ensure you have the best care and that the surgery is safe. HIV alone is not a reason to not perform surgery, especially now that you are on treatment.
Good luck with the surgery,
Josh.
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