Journal sur le SIDA et la recherche clinique

Background: People living with HIV infection have a longer survival rate after the introduction of Highly active antiretroviral therapy (HAART). Hence major resections in these patients can be performed safely.

Materials and methods: 5 retro positive patients underwent minimally invasive esophagostomy (MIE) in our institution between 2010 and 2015. Patient demographics, HIV status (CD4 count and viral load), Post-operative mortality, technical feasibility and outcomes were analyzed.

Results: Out of the 5 thoraco-lap esophagectomies, none required conversion. One patient died in the postoperative period due to overwhelming chest infection and sepsis (mortality - 20%). Two patients (40%) required prolonged ventilatory support in the postoperative setting. We had anastomotic leak in one patient (20%), which settled spontaneously. The expired patient carried maximum viral load (1,57,454) and lowest CD4 count (120).

Conclusion: Minimally invasive esophagectomy is a safe and viable option in retro positive patients, wherein the morbidity of laparotomy and thoracotomy are avoided. We report, what we believe is the first pilot case series of 5 minimally invasive esophagectomies in HIV positive patients and we believe that this study will be the shoulders for the next generation of investigators to stand on.

The purpose of this paper is to illustrate how professional service providers must understand the current traumainformed knowledge and contemporary understanding of the impact of interpersonal violence in the lives of persons living with HIV. If they do, there will be less impact and more healing regarding trauma, its trans-generational impact and increased quality of life for those living with HIV. In addition, a trauma-informed lens invites there to be a development of universal best practice, consisting of protocol and strategies that ask specific questions regarding what types of abuse or neglect people have experienced and when. This paper offers a theoretical framework, while matching relationship-focused questions as key to building new health prevention strategies that will reduce risk factors and increase the protective factors, when addressing this social epidemic called interpersonal violence, its impact and relationship, with the co-morbid health issue of HIV.