Human immunodeficiency virus therapy and potential anesthetic interactions

Abstract

URING the past decade, remarkable progress has been made in the treatment of patients infected with the human immunodeficiency virus (HIV). The pharmacologic arsenal used to combat HIV and its effects on the immune system has allowed many patients to lead longer and more meaningful lives, l Patients with the acquired immunodeficiency syndrome (AIDS) are similar, in many respects, to other patients with chronic medical illnesses, such as renal failure or cardiac disease. In addition, patients with HIV may manifest an array of secondary medical conditions associated with AIDS. Patients with AIDS are treated with a variety of pharmacologic agents that may cause secondary organ changes or dysfunction. Three major classes of drugs have emerged for use in the primary treatment of AIDS: nucleoside analogs, nonnucleoside analogs, and protease inhibitors (Table 1). 2 These drugs are clearly effective in short-term studies, but their long-term efficacy has not yet been reported. However, regardless of the positive impact these agents have made on the lives of individuals with HIV, the chemotherapeutic agents are beset with side effects and untoward drug interactions. Despite the negative effects of therapy, sophisticated anti-HIV therapeutic regimens have allowed patients with HIV to experience an increased life expectancy. Before the institution of combination therapy with reverse transcriptase and protease inhibitors, it was extremely unusual for patients with AIDS to undergo any surgical procedures other than those directly related to their immune dysfunction. Because of this increased survival time, patients with AIDS may now present to the operating room for virtually any type of surgical procedure. Not only do patients with HIV undergo common procedures, some medical centers are even including AIDS patients as organ transplant recipients? The complexities of caring for patients with HIV has forced many physicians in the medical community to question whether the medical and surgical management of these patients resides with general practitioners or specialist providers. 4's At the forefront of providing care to every patient presenting to the operating room is the anesthesiologist. As a central member of the perioperative care team, the anesthesiologist must be familiar with the medical needs and considerations that are specific to the patient with AIDS. Specifically, the goal of every anesthesiologist managing patients with AIDS must be to understand the types of drugs commonly used in eradicating the virus that causes AIDS, their pharmacokinetic effects, and the potential interactions of these drugs with anesthetic agents.