Modern medical advancements and significant progress in antiretroviral therapy (ART) have fundamentally changed the historical perception that HIV automatically increases surgical risk. Individuals living with HIV can now safely undergo nearly any necessary surgical procedure. Today, the decision to proceed with surgery is primarily based on a person’s overall health and the specific metrics of their HIV status, rather than the diagnosis itself. Elective and non-elective surgeries are routinely performed, demonstrating that a person with HIV is a suitable candidate for a wide range of operations.
Current Standards for HIV and Surgery
The safety of surgery for people with HIV is rooted in the current standard of medical care, which focuses on universal precautions. These protocols involve treating the blood and body fluids of every patient as potentially infectious, irrespective of their known health status. This approach ensures a consistently high level of protection for the surgical team during all procedures.
The risk of HIV transmission from a patient to a healthcare worker during surgery is low when universal precautions are followed. Modern data supports the idea that the viral concentration in the blood of a person on effective therapy is minimal, further decreasing risk. Healthcare teams adhere to guidelines that include the use of personal protective equipment and specific protocols for managing accidental exposure.
Medical Readiness Before the Procedure
For any non-emergency surgery, the patient’s HIV status must be medically optimized to ensure a smooth recovery. The two primary laboratory markers that guide this readiness are the HIV viral load and the CD4 T-cell count. These results provide a clear picture of how well the virus is controlled and the strength of the person’s immune system.
The goal for elective surgery is a fully suppressed HIV viral load, defined as fewer than 200 copies of the virus per milliliter of blood. Achieving this suppression significantly lowers the risk of post-operative complications to a level comparable to that of a person without HIV. A high viral load suggests active viral replication, which can increase the likelihood of infection or delayed healing.
The CD4 T-cell count measures a type of white blood cell and assesses the immune system’s health. For surgery to proceed without undue risk, the count should ideally be above 200 cells per cubic millimeter. A CD4 count below this threshold indicates a compromised immune system, which is associated with a higher rate of complications, including post-surgical infections.
Coordination between the surgeon and the patient’s HIV specialist is essential to the entire process. If a patient’s viral load is elevated or their CD4 count is low, the surgical procedure may be postponed. The condition can often be improved with adjusted antiretroviral therapy. This collaborative approach ensures the patient enters the operating room with the most robust internal defense system possible.
Managing Medication and Recovery
Management of the patient’s Antiretroviral Therapy (ART) regimen is crucial during the perioperative period. ART must be continued without interruption, even immediately before and after the procedure. Stopping the medication, even briefly, can lead to a rebound in viral activity and potentially increase the risk of drug resistance.
The surgical team, including the anesthesiologist, must review the patient’s specific ART medications to identify potential drug-drug interactions. Certain antiretrovirals, such as protease inhibitors, can affect how the body processes other medications, including sedatives or pain relief drugs like fentanyl. These interactions can increase the concentration of anesthetic drugs, leading to side effects, or decrease the ART level, risking viral rebound.
Adjustments to the dosages of anesthesia or post-operative pain medication may be necessary to safely manage these interactions. If the patient is temporarily unable to take oral medication, the care team coordinates with the HIV specialist to determine the safest alternative route or formulation. The patient should clearly communicate their medication schedule to all nurses and doctors to ensure seamless administration during the hospital stay.
Following surgery, the recovery phase for an individual with HIV is managed similarly to that of any other patient. Close monitoring for signs of infection or delayed wound healing is important, especially if the patient’s viral load was not fully suppressed or their CD4 count was low before the operation.