The clinical characteristics and outcomes of appendicitis in a population with a high HIV-infection prevalence

INTRODUCTION: In Botswana, the prevalence of HIV-infection is high (20.1%). Literature on characteristics of appendicitis in a high HIV-infection prevalence is limited. METHOD: A retrospective medical records review was conducted in patients admitted with a diagnosis of appendicitis and known HIV-infection status to adult surgical wards at Princess Marina Hospital from 2013 to 2019. Patients’ demographics, clinical characteristics, laboratory data, management and outcomes were analysed. RESULTS: A total of 601 appendicitis patients with known HIV-infection status were identified. Males contributed 51.9%. The overall median age was 29-year: 25-year for HIV-negative patients (HIV-NP) and 36-year for HIV-positive patients. HIV-NP had significantly higher rate of WBC count >10,000/μL, p=0.034. Appendectomy was performed in 92.8% of the cases. Non-operative treatment failure rate in one year was 35.4%. A total of 58 complications were recorded including 20 surgical site infections (SSIs) and one mortality in HIV-NP and 11 SSIs and six mortalities in HIV-positive patients (HIV-PP). HIV-PP had significantly higher mortality than HIV-NP, p=0.010. The overall hospital stay between operated and non-operated patients, p=0.996 and hospital stay between HIV-NP and HIV-PP were not different, p=0.223. Female patients had a significantly higher normal appendix and chronic appendicitis rates than males, p=0.032 and p=0.018 respectively. Complex appendicitis was associated with longer pre-hospital symptom duration, p=0.008 and longer hospital stay, p= 0.001, but it was not related to mortality, p=1.000. Among operated HIV-PP, patients with CD4 count <200 had a significantly higher mortality rate than those with ≥200, p=0.043. CONCLUSION: In Botswana, the prevalence of HIV-infection in patients with appendicitis was higher than the rate in the general population. HIV-infection and low CD4 count had an adverse effect on the mortality of patients with appendicitis. The higher HIV-infection rate in appendicitis patients and the impact of antiretroviral drug and viral-load on the outcomes in HIV-PP worth investigating.