6.17
Immune Disease

Acquired Immunodeficiency Syndrome (AIDS)

Etiology/Risk Factors
- Sexual transmission
- Exposure to infected blood
- Perinatal transmission
Pathophysiology
- Chronic infection with retrovirus HIV
- Can be asymptomatic
- Patients with HIV infection who are treated before significant immunosuppression occurs have close to normal life expectancy
- Immune suppression may lead to opportunistic infections:
  - Candidiasis
  - MRSA
  - Herpes simplex
  - Molluscum contagiosum
Treatment
- Highly active antiretroviral therapy (HAART)
- Nucleoside reverse transcriptase inhibitors
- Non‐nucleoside reverse transcriptase inhibitors
- Protease inhibitors
- Integrase strand transfer inhibitors
- Entry inhibitors
- Stem cell transplant
Primary Concerns
- Medications and effects on anesthetic agents
- Immune suppression
Evaluation
- Current therapy
- Current HIV/AIDs symptoms
- Current staging (Figure 6.43)
- Consider CBC
- Consider BMP
- Consider PT/PTT/INR
- Consider LFTs
- Consider echocardiogram, if cardiac abnormalities suspected
Anesthesia Management
- Universal standards for PPE do not change for patients with diagnosed blood‐borne transmissible diseases
- Typically, a well‐controlled HIV‐infected patient has little increased risk during surgical procedure [134]
- No specific anesthetic technique favored
- Autonomic neuropathy may be clinical
- Consider immune suppression of anesthetics and perioperative stress response

Etiology/Risk Factors
- Cause unclear
- Female
- Multifactorial
  - Genetic susceptibility
  - Environmental triggers
  - Viral infection serving as antigenic trigger through molecular mimicry
Pathophysiology
- Autoimmune inflammatory demyelinating disease of CNS (Figure 6.44
  
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Oct 16, 2024 | Posted by mrzezo in Oral and Maxillofacial Surgery | Comments Off