Human Immunodeficiency Virus: Anesthetic and Obstetric Considerations

Abstract

The pandemic of acquired immune deficiency syndrome (AIDS) is on the threshold of its third decade of existence. The World Health Organization-United Nations statistics show that human immunodeficiency virus (HIV)/AIDS pandemia is set to get much worse. Women of reproductive age are the fastest growing population with HIV. Common signs and symptoms have become more moderate or subclinical, and new clinical presentations have emerged. It is quite apparent that HIV-disease affects multiple organ systems. Advances have been made in elucidating the pathogenesis of HIV. In addition, the molecular technique of viral load determination and the CD + 4 T-lymphocyte count enable evaluation of the disease, its prognosis, and its response to therapy. There is limited specific information concerning the overall risk of anesthesia and surgery of HIV/AIDS patients. However, as far as can be determined, surgical interventions do not increase the postoperative risk for complications or death and should therefore not be withheld. There is also little evidence to suggest that HIV or antiretroviral drugs increase the rate of pregnancy complications or that pregnancy may alter the course of HIV infection. General anesthesia is considered safe, but drug interactions and their impact on various organ systems should be considered preoperatively. Regional anesthesia is often the technique of choice. Yet, one must take into consideration the presence of neuropathies, local infection, or blood clotting abnormalities. It should be emphasized that all practicing anesthesiologists should be familiar with the disease and should use prenatal anesthesia consultations and a team approach to assure optimal treatment for HIV patients.

Effects of different anesthetic approaches on postoperative complications in HIV-infected patients

“…In this study, patients with HIV infection had compromised immune function and some patients also suffered from other infections. Indeed, exogenous infection through intravertebral anesthesia was found to be a risk factor that accelerated the development of disease (Evron et al, 2004). However, our results indicated that intravertebral anesthesia did not increase the incidence rate of nervous system infection.…”

“…In addition, they have a low tolerance to injury (Lund et al, 2011;Klein et al, 2014;Redman et al, 2014). In recent years, these patients have undergone an increasing number of surgical procedures (Karpelowsky et al, 2011), and several anesthetic approaches have been studied previously (Evron et al, 2004;Bornard et al, 2011). At present, there are no special anesthetic drugs or methods to administer to HIV-infected patients (Krugova et al, 2010;Bajwa and Kulshrestha, 2013).…”

Anaesthetic considerations of the HIV-infected patients

“…Myelopathy, vertebral or spinal neoplasms, CNS infections are the main concern. There are studies on central neural blockade in obstetrics and epidural blood patch without any adverse events, provided that the patients do not have any neurologic symptoms [42][43][44][45][46][47][48][49][50][51]. However, the risks of developing neurologic complications following central neural blockade in HIV-infected patients are not known.…”

Anaesthetic considerations for the HIV positive parturient

“…This will allow a good prediction for the perioperative risk of the HIV-patient to be constructed. 9 The history should include evaluation of concurrent treatments with antiretroviral or anti-opportunistic drugs. The laboratory work up should include complete blood count, clotting functions, glucose, liver and renal functions test.…”

“…the CD4+ lymphocyte cell count and viral load during the previous 3 months is important. 9 Chest radiograph and electrocardiogram should be performed in all patients. Patients with a history or signs of cardiac or pulmonary dysfunction should undergo a more thorough evaluation (blood gases, echocardiography etc).…”