The rising incidence of human immunodeficiency virus (HIV) positivity will present new surgical challenges. The association of HIV infection with calculous and acalculous cholecystitis is not widely known. Opportunistic infections with cytomegalovirus (CMV)', cryptosporidium* or a combination of both3, and with more common pathogens4, have all been described. Early experience is reported.
Patients and methods
Eight HIV-positive patients (four men and four women of age range 21-41 years), all of whom were intravenous drug abusers, underwent cholecystectomy. The operation was performed laparoscopically in seven. Four patients had an acquired immune deficiency syndrome (AIDS)-detining infection: three with Pneumocystis carinii pneumonia and one with cryptosporidium infection. Pneumonia occurred in combination w i t h Salmonella and cryptosporidium infection (Table 1). Three patients also had hepatitis B and/or C. Gallstones were present in four patients. A thickened gallbladder wall was a consistent finding on ultrasonography, particularly in patients with acalculous cholecystitis.
Results
Four patients had proven gallstones and underwent cholecystectomy. This was conventional in one who presented acutely and laparoscopic in three presenting with intermittent attacks of typical gallbladder pain. There were no complications. AU patients had symptomatic benefit although follow-up in two was short.
600 3 0 4C1 YeS No No No No YeS Yes Yes None 10 YeS Pneumocystis carinii pneumonia and 9 Yes Salmonella None 2 Yes Pneumocystis carinii pneumonia and 2 No Cryptosporidium 3 No None 2 Yes None 2 ? Pneumocystis carinii pneumonia 2 ? cryptosporidium ~~