Perioperative ART Continuity — SCE Infectious Diseases MCQ

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EasyHIV MedicinePerioperative ART ContinuitySCE Infectious Diseases

A 30-year-old man with HIV on DTG/TAF/FTC (CD4 550, VL <50) develops acute appendicitis requiring emergency laparoscopic appendicectomy. He is fasted pre-operatively. His ART doses are due during the fasting period. What is the advice regarding ART during the perioperative period?

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Correct answer: D — ART should be continued perioperatively — DTG can be given with a small sip of water even while fasting; minimise ART interruption to maintain viral suppression

ART should be continued throughout the perioperative period to maintain viral suppression. Even during fasting, oral ART can be given with a small sip of water (confirmed with the anaesthetic team). DTG is taken once daily and can be timed to fit around theatre times. If the patient cannot take oral medication for a prolonged period (>48 hours), alternative delivery methods (NG tube if in situ) should be considered. Interrupting ART risks viral rebound, resistance development (particularly with NNRTI-based regimens that have long half-lives), and immune deterioration.

Reference: BHIVA 2022 – Perioperative ART; NICE 2024