HIV Infection: Its Impact on Patients with Appendicitis in Botswana

  • Alemayehu Ginbo BedadaEmail author
  • Marvin Hsiao
  • Georges Azzie
Surgery in Low and Middle Income Countries



To compare the presentation, management, and outcome of HIV-positive patients with appendicitis to those of HIV-negative patients with appendicitis. Summary Background Data: The literature is limited regarding the impact of HIV infection on patients with appendicitis.


A retrospective review of patients with appendicitis and known HIV status admitted to Princess Marina Hospital, Gaborone, Botswana, aged 13 years and greater was performed from January 2013 to December 2015. Data on patient demographics, presentation, laboratory findings, management, and outcomes were analyzed.


A total of 295 patients with appendicitis and known HIV status were identified, of which 119 (40.3%) were HIV positive. The median [IQR] ages for HIV-positive and HIV-negative patients were 34 [29–42] and 26 [20–33] years, respectively. The male-to-female ratio for the same two groups was 0.8:1 and 1.4:1, respectively. Presenting symptoms, signs, and white blood cell count were similar in both groups. HIV-positive patients had significantly higher overall (4.2 vs. 0.0%, p = 0.010) and postoperative (4.4 vs. 0.0%, p = 0.024) mortality rates. There was no significant difference in the total complication rate between HIV-positive and HIV-negative patients (13.2 vs. 7.9%, p = 0.192). Compared to HIV-positive patients with a CD4 count ≥200, patients with a CD4 count <200 have a significantly higher postoperative mortality rate (17.6 vs. 1.4%, p = 0.023) and a trend toward a higher total postoperative complication rate (31.3 vs. 10.8%, p = 0.054).


Within our setting, HIV infection, particularly with a CD4 <200, was correlated with significantly higher mortality in patients with acute appendicitis.


Authors contributions

This study was conceived by AGB. The study design was made by AGB, MH, and GA. Data were collected by AGB and analyzed by AGB and MH. Data interpretation was done by all authors. The first draft of the manuscript was made by AGB and critically revised by all authors. All authors have approved this version of the manuscript to be submitted and published by World Journal of Surgery.

Compliance with ethical standards

IRB Approval

Permission to conduct this study was granted by the Institutional Review Board at Princess Marina Hospital and the Ministry of Health and Wellness of Botswana. No patients were contacted, or their identifiers were collected in order to ensure anonymity.

Supplementary material

268_2019_5040_MOESM1_ESM.docx (11 kb)
Supplementary material 1 (DOCX 10 kb)


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  1. 1.Department of Surgery, Faculty of MedicineUniversity of Botswana, Princess Marina HospitalGaboroneBotswana
  2. 2.Division of General SurgeryRoyal Columbian HospitalVancouverCanada
  3. 3.Division of General and Thoracic SurgeryHospital for Sick ChildrenTorontoCanada

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