Establishing the significance of a pre-operative day absolute CD4 count in patients booked for elective brain tumor surgery – A prospective cohort study from a single neurosurgical center in South Africa

Abstract

Introduction: Unlike the situation in many 1st World-countries, new HIV infections in South Africa continue to rise. While mandatory HIV testing is unethical, a pre-operative absolute CD4 count can be performed in patient’s pre-elective brain tumour surgery. Materials and methods: This was a prospective cohort study performed by consecutively enrolling 78 patients admitted to the adult neurosurgical wards at our hospital, from the 01 July 2018–30 March 2020, with neoplastic brain tumours that were taken for elective resection. Data collected and analysed in this study included subject age, gender, HIV status, admission absolute CD4 count, admission Glasgow Coma Score, pre-operative corticosteroid therapy, length in in-hospital stay prior to surgery, pre-operative day absolute CD4 count, operative day Glasgow Coma Score, intra-operative blood loss, duration of surgery, extent of resection, histological diagnosis, day-7 nosocomial infection incidence, and Glasgow Outcome Score. Results: High significance was demonstrated between admission absolute CD4 count and the pre-operative day absolute CD4 count (p < 0.0001). With regards elective brain tumour surgery the relationship between the use of pre-operative steroids and the pre-operative absolute CD4 count is insignificant (p = 0.73). While no significance was demonstrated (p = 0.93), a clinical trend was suggested that the lower the pre-operative day absolute CD4 count, the longer the duration of surgery. No significance was demonstrated between pre-operative CD4 count and histology result (p = 0.45), although our results suggested a trend for cancers, of known and suspecting links to infective aetiology, to cluster in subjects with a pre-operative CD4 count < 500 cells/mm. No significance was demonstrated between pre-operative CD4 count and day 7 nosocomial infection incidence (p = 0.59). Conclusion: HIV infection, and its complications, remain very real to HIV positive patients presenting with brain tumours in South Africa. Through the trends demonstrated we recommend the use of a pre-operative absolute CD4 count in the work-up of these patients.