HIV and anaesthesia

Safiya Imtiaz Shaikh,Paramesh Suresh Kenchannavar

doi:10.7439/ijbr.v5i1.484

HIV and anaesthesia

Safiya Imtiaz Shaikh, Paramesh Suresh Kenchannavar

Open Access

https://doi.org/10.7439/ijbr.v5i1.484

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Abstract

The pandemic of AIDS (Acquired immune deficiency syndrome) is virtually creating a panic among healthcare workers. Out of 40 million HIV infections 5.2 million are in India 1 . Because the advances in treatment of HIV infection increase the patient's survival, anaesthesiologists may care for these patients during their practice. HIV infection is a spectrum of disease varying from asymptomatic to multiple organ involvement. Safe anaesthetic management in HIV-infected patients includes understanding basic knowledge of HIV infection, organ involvement, pharmacology and adverse reactions of antiretroviral agents. There are no specific anaesthetic agents and techniques for HIV-infected patients. General anaesthesia should not be withheld on the grounds of HIV infection alone. Regional anaesthesia is safe but one must consider local infection, bleeding problems and neuropathies. Infection control to prevent transmission of infections to and from HIV-infected patients must be strictly conducted.

Highlights

The acquired immunodeficiency syndrome (AIDS) was first described in the United States in 19812
AIDS is an increasingly recognized cause of, or strongly linked to cardiomyopathy, pulmonary hypertension, right ventricular dysfunction, myocarditis, pericardial effusion, and coronary artery disease .highly active antiretroviral therapy (HAART)( Highly active antiretroviral therapy ) decreases the incidence of pericardial disease at the cost of increased coronary artery disease due to dyslipidaemia associated with some antiretroviral drugs[12].Cavitatory lung disease can be due to pyogenic bacterial lung abscess, pulmonary tuberculosis, fungal infections and Nocardia species
Antiretroviral drugs in current use fall into three categories: (i) Nucleoside analogue reverse transcriptase inhibitors (NRTI), e.g. Zidovudine – inhibit the synthesis of DNA by reverse transcriptase by acting as false nucleotide. (ii) Non-nucleoside reverse transcriptase inhibitors (NNRTI) e.g. Nevirapine – bind to reverse transcriptase in a way that inhibits enzyme activity, and (iii) protease inhibitors (PIs) e.g. Saquinavir – prevent the processing of viral proteins into functional forms

Summary

Introduction

The acquired immunodeficiency syndrome (AIDS) was first described in the United States in 19812. Hematologic abnormalities occur with acute HIV infection and are a hallmark of the disease This is seen with the dev elopment of HIV -thrombocytopenia as the disease progresses secondary to a number of causes, including retroviral infection of megakaryocytes, or drug induced thrombocyptopenia[5]. AIDS is an increasingly recognized cause of, or strongly linked to cardiomyopathy, pulmonary hypertension, right ventricular dysfunction, myocarditis, pericardial effusion, and coronary artery disease .HAART( Highly active antiretroviral therapy ) decreases the incidence of pericardial disease at the cost of increased coronary artery disease due to dyslipidaemia associated with some antiretroviral drugs[12].Cavitatory lung disease can be due to pyogenic bacterial lung abscess, pulmonary tuberculosis, fungal infections and Nocardia species. Hyperinsulinaemia, lipodystrophy, hyponatraemia, hyperkalaemia have been reported

Treatment

Drug interactions

Perioperative management of ARVs

Anaesthetic management plan

Findings

Conclusion