HIV and AIDS

Learning objectives

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system, making a person more vulnerable to other infections and diseases
If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome)
Effective treatment with antiretroviral therapy to reduce the viral load is available, however, no cure exists
AIDS is the late stage of HIV infection that occurs when the body’s immune system is badly damaged because of the virus

Stage 1: acute HIV infection	Stage 2: chronic or clinical latent HIV infection	Stage 3: acquired Immunodeficiency Syndrome (AIDS)
A large amount of HIV in the blood which is very contagious Flu-like symptoms	Asymptomatic HIV infection or clinical latency HIV is still active and continues to reproduce Patients may not have any symptoms but can still transmit HIV Intake of HIV treatment can prevent the development of stage 3 (AIDS) At the end of this stage, the HIV viral load increases, and the patient moves into stage 3 (AIDS)	The most severe stage of HIV infection High viral load and may easily transmit HIV to other people Opportunistic infections or other serious illnesses People with AIDS typically survive about three years without HIV treatment
		A person with HIV is considered to have progressed to AIDS when: The number of their CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3) OR they develop one or more opportunistic infections regardless of their CD4 count

Protozoa	Pnemocystis carinii Toxoplasma gondii Cryptosporidium parvum Microsporidia spp. Isospora belli
Fungi and yeasts	Candida spp. Cryptococcus neoformans Histoplasma capsulatum Coccidioides immitis
Viruses	Cytomegalovirus Herpes simplex Varicella zoster
Bacteria	Mycobacterium avium intracellulare Mycobacterium tuberculosis Streptococcus pneumoniae Haemophillus influenzae Salmonella spp. Nocardia Moraxella catarrhalis

Highly active antiretroviral therapy (HAART) to slow the progression of the disease
Combination or cocktail of antiretroviral agents to prevent resistance to the virus, typically:
- a non-nucleoside reverse transcriptase inhibitor (NNRTI)
- Two nucleoside analog reverse transcriptase inhibitors (NRTIs)
Consider side effects of antiretrovirals:
- Bone marrow suppression
- Renal failure
- Peripheral neuropathy
- p450 activation
- Lactic acidosis
- Insulin resistance
- Dyslipidemia
Treatment of opportunistic infection

Preoperative management

Intraoperative management

Reduce the risk of cross infection
- Vigilance in the use of universal precautions
- Administer post-exposure prophylaxis (PEP) to healthcare workers as soon as possible after the injury, ideally within 1–2 hours
Obstetric anesthesia
- Cesarean section reduces the incidence of mother-to-child transmission
- Administer ART
- RA is not contraindicated
- Epidural blood patch for PDPH is safe
Pain management
Multidisciplinary pain management