Symptomatic Human Immunodeficiency Virus Infection Is Associated with Advanced Presentation and Perioperative Mortality in Patients Undergoing Surgery for Peripheral Arterial Disease

ABSTRACT OBJECTIVE While prior studies have demonstrated an increased risk of developing cardiovascular and peripheral arterial disease (PAD) in patients with human immunodeficiency virus (HIV), the effect of chronic HIV infection in patients with pre-existing PAD requiring vascular intervention is unclear. This study assessed the differences in clinical presentation and perioperative outcomes of PAD patients undergoing a revascularization or amputation procedure with and without HIV infection. METHODS ICD-9 and ICD-10-CM codes were used to identify patients with a prior diagnosis of PAD who underwent lower extremity revascularization or amputation procedure in the National Inpatient Sample (NIS; 2003-2017). From this group, patients were divided for analysis into those with and without HIV infection. Out of patients with HIV infection (PWH), we identified additional subsets with any prior or current diagnosis of a HIV-related illness including acquired immunodeficiency syndrome (AIDS) as symptomatic HIV, or not, which we designated as asymptomatic HIV infection. Propensity score matching was performed to create matched cohorts. Population-based comparative analyses were performed on clinical characteristics of HIV-infected and non-infected groups. Univariate and multivariate logistic regression analysis of perioperative in-hospital outcomes was performed on matched cohorts. RESULTS A total of 224,912 patients between ages 18-85 years were identified who were admitted with an established diagnosis of PAD and underwent a lower extremity procedure. 1,264 (0.56%) of these patients were also diagnosed with HIV infection. Symptomatic PWH were more likely to present with critical limb ischemia compared to HIV-uninfected patients or asymptomatic (PWH) (66.2% vs. 46.3 and 43.6%, p CONCLUSIONS Symptomatic PWH, including patients living with AIDS, undergoing a PAD-related procedure presented with more advanced vascular disease and were most at risk of early perioperative mortality however, presentation and mortality rates between asymptomatic PWH with well-controlled disease and HIV-uninfected patients were comparable. All HIV-infected patients with PAD were more likely to undergo lower extremity amputations than HIV-uninfected matched controls. Asymptomatic, well-controlled HIV infection should not be a contraindication to elective PAD-related procedures as mortality is similar to non-infected individuals however, limb salvage rates may be lower among all PWH with PAD regardless of HIV disease severity. Taken together, these findings can improve perioperative risk stratification and surgical management of PAD in this high-risk population.