ABSTRACT
Many surgeons have extensive experience with immunocompromised patients. Promi-
nent among these patients are those with cancer, those who receive radiation and che-
motherapy, and those who develop profound malnutrition following surgery in
association with infectious and other complications in the intensive care unit (ICU).
In addition, the induction and management of immunodeficiency among patients
following organ transplantation (particularly kidney, liver, heart, and other sites) has
long been the purview of surgical specialists. However, over the last two decades,
the emergence of the human immunodeficiency virus (HIV) and the acquired immuno-
deficiency syndrome (AIDS) as the leading causes of severe and prolonged immune
insufficiency in the United States has provided new medical, social, and ethical chal-
lenges for the surgical community. Physicians who attended medical school and com-
pleted residencies before the mid-1980s later found themselves confronted with novel
clinical problems for which no precedents and no clear guidelines existed. More
recently, the clinical experience associated with HIV infection, including both presen-
tations and outcomes of different syndromes, has been well documented and analyzed.
Increasingly effective interventions have been implemented to diagnose HIV infection,
to prevent and treat the secondary opportunistic infections that complicate HIV disease,
and to treat HIV infection itself. The incidence of HIV infection in the United States
has remained stable or decreased, but the prolonged survival associated with highly
active antiretroviral therapy (HAART) (1,2) has also introduced new variables, such
as an increased rate of cardiac disease and liver failure, and non-HIV-associated age-
related conditions that may require surgical evaluation and intervention.
