Human Immunodeficiency Virus

Yan L, Ellman T, McNairy M, McGowan JP, Fine SM, Vail RM, Merrick ST, Radix AE, Hoffmann CJ, Gonzalez CJ. Perioperative Care in Adults With HIV. Baltimore (MD): Johns Hopkins University; 2021 Nov 16. PMID: 34982516.

Bottom line: 

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This guideline was developed by the New York State Department of Health AIDS Institute. It was originally published on November 16, 2021 as an update to the original 2012 guideline and most recently updated on May 9, 2022. This guideline uses a strength recommendation grading scheme. The following major points are rated as strong recommendations.

Major points:

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1. Determining CD4 count or HIV viral load should not delay emergency or urgent surgery.

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2. For elective surgery, one should obtain HIV viral load test within 6 months and CD4 count within 12 months.

3. Low CD4 count and an uncontrolled viral load is associated with an increased risk for postoperative mortality and complications.

4. If viral load <200 copies/mL and CD4 count >200 cells/mm3, the surgical plan may proceed as if patient does not have HIV.

5. For elective surgery in patients who are not virally suppressed consultation with an HIV Care Provider for optimization should be obtained promptly.

6. Interruptions in antiretroviral therapy and opportunistic infection prophylaxis or treatment should be avoided.

7. There is increased potential for drug-drug interactions in patients taking ART due to cytochrome P450 interactions with protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and boosters such as ritonavir or cobicistat.

8. With universal surgical precautions the risk of HIV transmission is extremely low.

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