Question: What should be done with anti-retroviral therapy drugs on the day of

Clinical answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 10 May 2026Updated: 10 May 2026 Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Recommended management of antiretroviral therapy (ART) on the day of surgery for a patient with HIV involves continuing the patient's regular ART regimen without interruption on the day of surgery unless there are specific contraindications or specialist advice to the contrary.

Discontinuing or adjusting antiretroviral drugs without specialist consultation is not recommended due to risks of treatment resistance and viral rebound. A detailed medication history including ART should be taken, and potential drug interactions with perioperative medications must be carefully reviewed. If in doubt, preoperative planning should involve the patient's HIV specialist or multidisciplinary team to manage complex interactions or side effects carefully, ensuring sustained viral suppression and minimising perioperative complications.

Continuity of ART is important to maintain viral suppression and immune function through the perioperative period. Any concerns about adherence, adverse effects, or interactions should be addressed before surgery with specialist input.

Perioperative care should include vigilant monitoring of renal and hepatic function, as some ART drugs have potential nephrotoxic or hepatotoxic effects, particularly when combined with other drugs commonly used in surgery such as NSAIDs or anaesthetic agents. Dose adjustments for other renally excreted drugs may be necessary depending on the ART regimen.

There is no need to stop or alter ART drugs solely due to surgery, and no anesthetic agents are contraindicated based on ART use alone. Preoperative optimization includes ensuring up-to-date immunisations and ongoing management of comorbidities common in people with HIV, such as cardiovascular disease and diabetes.

In specific circumstances such as intravenous zidovudine use during cesarean section for prevention of maternal-fetal transmission, infusion timing is important (e.g., started 4 hours before operation), but this is a specialized obstetric context rather than general surgery.

The overall principle is to maintain ART uninterrupted on the day of surgery to avoid virological failure or resistance, whilst collaborating closely with HIV specialists to manage potential drug interactions and comorbidities for optimal perioperative safety.

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