Impact of Preoperative Viral Load on Postoperative Outcomes in HIV-Positive Surgical Patients in Cameroon: A Five-Year Retrospective Study

Background: People living with HIV (PLHIV) increasingly require surgical care due to improved survival associated with antiretroviral therapy (ART). However, immunosuppression reflected by uncontrolled viral replication may influence postoperative outcomes. Evidence from sub-Saharan Africa remains limited. Objective: To evaluate the impact of preoperative viral load on postoperative outcomes among HIV-positive surgical patients in two regional hospitals in Cameroon. Methods: A retrospective multicenter analytical study was conducted in Buea and Limbe Regional Hospitals from January 2020 to December 2024. HIV-positive patients who underwent surgery and had documented preoperative viral load were included. Viral load was categorized as suppressed (<1000 copies/mL) or unsuppressed (≥1000 copies/mL) according to WHO recommendations. Postoperative outcome was classified as favorable or poor (postoperative complication, death, referral, or discharge against medical advice). Associations were assessed using chi-square tests and multivariate logistic regression. Results: Among 314 HIV-positive surgical patients, 112 (35.7%) had unsuppressed viral load. Poor postoperative outcome occurred in 27.7% of patients with unsuppressed viral load compared with 11.5% among those with suppressed viral load (p = 0.003). Surgical site infection and prolonged hospitalization were more frequent among patients with unsuppressed viral load. After adjustment for potential confounders, unsuppressed viral load remained independently associated with poor postoperative outcome (adjusted OR 2.8; 95% CI 1.4 - 5.6). Emergency surgery was also an independent predictor of poor outcome. Conclusion: Unsuppressed preoperative viral load significantly increases the risk of adverse postoperative outcomes among HIV-positive surgical patients in Cameroon. Optimization of viral suppression before surgery should therefore be prioritized to improve surgical outcomes in resource-limited settings.