Study for wound healing in HIV-infected patients

本研究旨在建立HIV感染晚期创面愈合能力较差患者的手术指征标准。实验用B6小鼠制备了maid。与对照小鼠相比，maid愈合皮肤切口的断裂强度降低了八分之一。我们试图从接受手术的HIV感染患者的一块皮肤上建立成纤维细胞细胞系，但我们无法建立细胞系。HIV不感染培养的正常成纤维细胞。临床上，我们研究了3例（IV期）腹股沟斜疝修补术和5例（III期：1例，IV期：4例）剖腹手术的伤口愈合延迟。所有病例均需2 ~ 4周创口愈合，无瘢痕疙瘩形成。即使CD4阳性细胞计数低于100/ ml，在HIV感染和HIV指标疾病可控的情况下，伤口也会愈合。根据Montaner分期系统，我们提出hiv感染者的手术指征标准如下：对于第一阶段，评估是根据通常的指标进行的。在第二阶段，应考虑与艾滋病毒有关的发病机制。对于第三阶段和第二阶段，应该进行治疗性手术。对于第四阶段，主要考虑姑息性手术以减轻症状，但如果患者的一般情况良好，则可以进行治疗性手术。

The purpose of this study is to establish the criteria of surgical indications for HIV infected patients whose abillity of wound healing is poor in late stage of HIV infection.Experimentaly we made MAIDS using B6 mouse.The breaking strength of a healing skin incision in the MAIDS was decreased one eighth comparing the strength in a control mouse.We tried to establish cell lines of fibroblast from a piece of skin of HIV infected patients who received operation but we could not established cell lines.HIV did not infect cultured normal fibroblasts.clinically we studied delay of wound healing for 3 patients (stage IV) who received repair of indirect inguinal hernia and for 5 patients (stage III : 1, stage IV : 4) who received laparotomy.In every case, it took 2-4 weeks for healing of wound incision without keloid formation.Even if the cell count of CD4 positive cells was less than 100/mul, wounds would heal on condition that HIV infection and HIV-indicator diseases are controllable.According to Montaner's staging system, we propose criteria for surgical indication for HIV-infected patients as follows.For stage I,assessment is made by the usual indications.In stage II,consideration should be given to HIV-related pathogenesis.For stage III as for stage II,curative operations should be performed.For stage IV,primary consideration is given to palliative operations for alleviating symptoms but if the general condition of the patient is good, a curative operation may be performed.