Multisystem Involvement of HIV

To enable a thorough preoperative assessment it is important to be aware which organ systems can be involved in the HIV infected patient, both as a direct consequence of HIV infection due to opportunistic infection or neoplasm, as well as related to other causes such as side effects of the ARV medications.

Cardiovascular System

Advances in the treatment of HIV infection have improved longevity of HIV patients; thereby they develop more cardiac involvement. The cardiovascular system may be involved in a number of ways in HIV infection. There may be pericardial, myocardial, endocardial or vascular lesions, as well as neoplasm. These may be directly related to HIV infection or to the side effects of ARVs, chemotherapy or anti-infective agents. There are reports of various abnormalities associated with a hypercoagulable state. These include pulmonary hypertension, accelerated coronary arteriosclerosis, a decrease in left ventricular contractility to a hypercoagulable state that correlate with the severity of HIV disease. The coexistence of HIV related illness, such as malignancies and autoimmune disease, as well as antiretroviral drug therapy itself, may also predispose these patients to thromboembolic events.

Another coagulation abnormality seen in the HIV patients is idiopathic thrombocytopenic purpura (is a blood clotting disorder that can lead to easy or excessive bruising and bleeding due to low platelet) that caused by platelet serum immunoglobulin, or direct adverse effects of HIV infection on the megakaryocytes (a bone marrow cell responsible for the production of platelet). Some of the antiretroviral (zidovudine) or anti-opportunistic drugs (ganciclovir) may contribute to these hematologic abnormalities as a result of bone marrow suppression.

Respiratory System

Both the upper and lower airway can be involved in HIV infection. These complications can be due to primary HIV infection, associated malignancies, opportunistic infections or side effects of medication. The following respiratory complications are seen; airway obstruction (by Kaposi sarcoma or infections), bronchitis, sinusitis, pneumonia and atypical infections (commonly tuberculosis, other mycobacteria and fungal infections).

Gastrointestinal System

Commonly encountered complications of the gastrointestinal tract associated with HIV infection and its treatment include:

  • Difficulty or pain on swallowing
  • Increased gastric emptying times
  • Bleeding tendency on airway instrumentation/nasogastric tube insertion
  • Diarrhea with associated electrolyte dysfunction & dehydration
  • Hepato biliary impairment
  • Pancreatitis.

Renal System

Acute and chronic renal disease can be associated with HIV and the causes of renal impairment can be multifactorial:

  • Drug-induced nephrotoxicity, hypertension & diabetes
  • HIV-associated nephropathy.

These potential complications necessitate the avoidance of nephrotoxic drugs, dose adjustment of renally excreted drugs and the need for adequate hydration to prevent further deterioration of renal function.

Neurological System

HIV can involve the neurological system by direct infection, inflammation, demyelination or a degenerative process. It can also be secondary to opportunistic infections, neoplasms or immune deficiency. This can involve all structures including the meninges, brain, spinal cord, peripheral nerve or muscle. Also recognized are:

  • Neurocognitive impairment (with implications for consent)
  • Encephalopathy
  • Autonomic neuropathy
  • Seizures.

Full neurological examination pre-operatively with appropriate documentation is essential especially if regional anesthesia is being considered.

Hematological System

The following are commonly seen during HIV infection:

  • Anemia
  • Neutropenia
  • Thrombocytopenia
  • Persistent generalized lymphadenopathy
  • Hematological malignancies
  • Coagulation abnormalities.

Endocrine & Metabolic System

Common side effects of ARVs include:

  • Lipodystrophy: disturbance of fat metabolism (truncal obesity, buffalo hump, peripheral wasting)
  • Metabolic syndrome (raised plasma triglycerides, cholesterol, and glucose)
  • Adrenal insufficiency
  • Hyponatremia due to adrenal failure
  • Hypo- or hyperthyroidism
  • Lactic acidosis
Last modified: Sunday, 20 November 2016, 6:09 PM