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Surgery in Well-Controlled HIV — SCE Infectious Diseases MCQ

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EasyHIV MedicineSurgery in Well-Controlled HIVSCE Infectious Diseases

A 35-year-old man with HIV on ART develops anal fissure with severe perianal pain and spasm. Conservative management (GTN ointment, stool softeners) has failed. He is referred for surgical assessment. His surgeon asks whether HIV affects surgical outcomes for anal fissure repair. What is the evidence?

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Correct answer: C — In well-controlled HIV (CD4 >200, VL suppressed), surgical outcomes for anorectal conditions including lateral internal sphincterotomy are comparable to HIV-negative patients — surgery should not be withheld

Modern ART has transformed surgical outcomes in PLWH. In patients with well-controlled HIV (CD4 >200, suppressed VL), wound healing and surgical outcomes for anorectal procedures are comparable to HIV-negative patients. Historical concerns about impaired healing in HIV were based on the pre-ART era when patients had advanced immunosuppression. Current BHIVA guidance supports standard surgical management of anorectal conditions in well-controlled HIV. CD4 <200 or active OIs are relative contraindications that may require optimisation before elective surgery.

Reference: BHIVA 2022 – Surgical considerations in HIV; ACPGBI 2024