Someone living with Human Immunodeficiency Virus (HIV) can have surgery. Modern medicine, particularly the development of effective antiretroviral therapy (ART), has transformed HIV from a rapidly progressive disease into a chronic, manageable health condition. This progress means that HIV status alone is not a contraindication for almost any surgical procedure. Instead of focusing on the virus itself, the surgical team focuses on the patient’s overall immune health and whether the virus is successfully controlled. When the virus is controlled, the risks associated with surgery for a person with HIV are often comparable to those of the general population.
Optimizing Health Status Before Surgery
The success of any surgical procedure for a patient with HIV is linked to their immune status, making the pre-operative period crucial for medical optimization. The goal is to ensure the patient’s body is prepared to handle the stress of surgery and the subsequent healing process. This preparatory work requires close coordination between the surgeon and the patient’s infectious disease specialist.
A suppressed viral load is a primary marker of health and safety before surgery. Viral load is the amount of HIV present in the blood. When this level is consistently low, typically less than 200 copies per milliliter, the patient has an undetectable status. This status significantly reduces the risk of post-operative complications and eliminates the risk of occupational transmission to healthcare workers. For elective surgeries, if the viral load is high (e.g., over 200 copies/mL), the procedure may be delayed to allow time for ART to achieve viral suppression.
The CD4 cell count, a measure of the patient’s immune function, is another factor in the pre-operative assessment. CD4 cells are white blood cells targeted by HIV; a high count indicates a stronger immune system. Patients with a CD4 count greater than 200 cells per cubic millimeter and a suppressed viral load generally face a risk of post-operative complications similar to that of non-HIV patients. If the CD4 count is less than 200 cells per cubic millimeter, the risk of post-operative infection and mortality increases, especially for complex procedures.
Preparing for surgery involves managing the antiretroviral medication regimen. Patients must maintain strict adherence to their ART schedule right up to the procedure to prevent the viral load from rebounding and compromising their immune status. The surgical team and the infectious disease specialist must review all medications for potential drug-drug interactions. Some ART medications, particularly certain protease inhibitors and boosters, can interact with drugs used in anesthesia or post-operative pain management. Adjusting the timing or dosage of either the ART or the perioperative medications may be necessary to ensure both treatments remain effective and safe.
Safety Protocols During the Procedure
Concerns about the transmission of HIV in the operating room are addressed through the consistent application of universal precautions. These are standard safety measures applied to every patient undergoing surgery, treating all blood and bodily fluids as potentially infectious, regardless of known health status. This approach ensures a high level of protection for the entire surgical team. Universal precautions include the mandatory use of protective barriers such as gloves, gowns, masks, and eye protection. Safe handling practices for sharp instruments are strictly enforced. Should an exposure occur, institutional protocols for post-exposure prophylaxis (PEP) are immediately initiated.
The patient’s HIV status rarely impacts the standard protocols for general anesthesia unless the disease has progressed to cause severe organ involvement. Anesthesiologists assess the patient based on their overall health, including any co-existing conditions. The specific HIV medications are noted, but the anesthetic agents themselves are chosen based on standard pharmacological principles.
A patient’s HIV status is protected health information, shared only on a need-to-know basis among the care team directly involved in treatment. This policy maintains patient confidentiality while ensuring the surgical team has the necessary information to provide the safest care. The primary purpose of sharing this information is not infection control, which is covered by universal precautions, but to manage potential drug interactions and monitor the patient’s immune function.
Managing Recovery and Long-Term Outcomes
The recovery phase for a person with HIV requires attention to wound healing and infection monitoring. While a patient with a suppressed viral load and a healthy CD4 count typically recovers well, there can be a slightly elevated risk for delayed wound healing or surgical site infections, especially if the CD4 count was low pre-procedure. Healthcare providers closely monitor the incision site for signs of infection, such as redness, swelling, or discharge.
Continued adherence to antiretroviral therapy is essential to the post-operative care plan. Interrupting ART, even briefly, can lead to a viral rebound, compromising the immune system and increasing the risk of infection and drug resistance. If the patient is unable to take medication orally immediately after surgery, the care team must consult the infectious disease specialist to arrange for alternative formulations or temporary adjustments.
Post-operative pain management must be coordinated to avoid the drug interactions identified during the pre-operative phase. Analgesics, particularly certain opioids, can be metabolized differently when taken alongside some ART drugs, potentially leading to toxic levels or reduced pain relief. The care team uses the pre-operative plan to select safe and effective pain medications.
Follow-up care involves both the surgical team and the patient’s infectious disease specialist. Regular checks with the surgeon focus on surgical recovery, while the infectious disease specialist ensures the HIV remains suppressed and the immune system recovers. Successful surgery does not negatively impact the patient’s long-term HIV management, and the patient can expect to return to their baseline health status.