Study for wound healing in HIV-infected patients

为探讨HIV感染后期伤口愈合能力差的病人的手术适应证，我们用B6小鼠制作了MAIDS，其愈合皮肤切口的断裂强度比对照小鼠降低了八分之一。我们尝试从HIV感染者的皮肤中建立成纤维细胞系我们对3例接受手术但无法建立细胞系的患者进行了临床研究，发现HIV病毒不感染培养的正常成纤维细胞（IV期）接受腹股沟斜疝修补术，5例患者（第三阶段：1，第四阶段：4）接受剖腹手术的患者。在所有病例中，伤口切口的愈合需要2-4周而没有瘢痕疙瘩形成。即使CD 4阳性细胞的细胞计数小于100/穆尔，根据Montaner分期标准，我们提出了HIV感染者的外科手术适应证标准，对于I期，根据通常的适应证进行评估;对于II期，应考虑HIV相关的病因;对于III期，如同对于II期一样，第四阶段主要考虑采取姑息性手术，以减轻症状，但如果病人的一般情况良好，也可以采取根治性手术。

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.