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HIV and AIDS 

 

Considerations

  • Need for universal precautions 

  • Multisystem disease:

    • CNS: Dementia, peripheral neuropathies, myopathys, encelphalopathy, masses with ↑ICP

    • Airway: upper a/w obstruction with Kaposi sarcoma, possible difficult intubation

    • Resp: Pneumonia, pHTN of HIV, opportunistic resp. infxns

    • CVS: Autonomic neuropathy, accelerated CAD for HART, HIV related DCM

    • Renal: End stage nephropathy GN

    • Heme: Anemia, thrombocytopenia, lymphopenia

    • Immunocompromised:

      • Opportunistic infections: Meningitis, encephalitis, pneumonia/TB, esophagitis, enteritis

      • Malignancy: Lymphoma, Karposi Sarcoma

    • Failure to thrive, Cachexia, and Deconditioning 

  • Medications (Antiretrovirals)

    • Bone marrow suppression

    • Renal failure

    • Peripheral neuropathy

    • p450 activation

    • Lactic acidosis

    • Insulin resistance

    • Dyslipidemia

  • Chronic pain and co-existing substance abuse

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Pregnancy Considerations

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  • ↓ perinatal transmission with AZT

  • Elective C/S may reduce risk of transmission.  All should be offered this but labor also ok esp. if Viral load <1000 copies/ml 

  • Regional OK (document peripheral neuropathy, coagulation, strict sterile technique with gown!) 

  • PDPH/blood patch NOT contraindicated 

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References 

  • Anaesthetic considerations of the HIV-infected patients. Current Opinion in Anaesthesiology: June 2009 - Volume 22 - Issue 3 - p 412-418

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