ART and Anaesthesia — SCE Infectious Diseases MCQ

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EasyHIV MedicineART and AnaesthesiaSCE Infectious Diseases

A 34-year-old man with HIV (CD4 540, VL <50 on BIC/TAF/FTC) develops gallstones requiring elective cholecystectomy. His anaesthetist asks whether any ART agents affect neuromuscular blocking drugs used during general anaesthesia. What is the advice?

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Correct answer: A — No clinically significant interaction between current INSTI-based ART (BIC/TAF/FTC) and standard anaesthetic agents including neuromuscular blockers — surgery can proceed without ART modification

Current first-line INSTI-based ART (BIC, DTG) does not interact with standard anaesthetic agents (propofol, sevoflurane, neuromuscular blockers, opioids). Historically, Ritonavir-boosted PIs had interactions with Midazolam and Fentanyl (CYP3A4 substrates), but these are no longer first-line. The key perioperative principle: continue ART throughout the perioperative period (including on the day of surgery with a sip of water). The Liverpool Drug Interactions database confirms no interactions for BIC/TAF/FTC with anaesthetic agents.

Reference: BHIVA 2022 – Perioperative ART; Liverpool Drug Interactions 2024