title: Perioperative concerns in neurosurgical patients with human immunodeficiency virus infection.
abstract: BACKGROUND
  The perioperative management of human immunodeficiency virus (HIV) infected patients undergoing neurosurgery is challenging due to the presence of HIV-related multi-system derangements, opportunistic infections and malignancies, history of substance abuse, and adverse effects of anti-retroviral therapy (ART), together with the inherent risks of neurosurgery. The possible adverse impact of HIV disease on the anesthetic outcome due to the associated co-morbidities, and conversely, the role of surgery and anesthesia in HIV disease progression due to their immunosuppressive effects, and also, the fear of HIV transmission among the attending medical personnel are the important perioperative concerns in such surgeries.
  
  
  OBJECTIVE
  To present our experience in the perioperative management of HIV-infected patients who underwent neurosurgery at our institute in the past 5 years and highlight the relevant perioperative issues.
  
  
  METHODS
  A retrospective analysis of the records of HIV-infected neurosurgical patients was undertaken to determine their HIV status and ART, anesthesia and surgery details, perioperative complications, and instances of postoperative worsening of HIV disease or its transmission, if any.
  
  
  RESULTS
  Seven HIV infected patients with variable severity of HIV infection and systemic disease underwent neurosurgery for different indications. Their perioperative management was modified in accordance with the co-morbidities and the type of neurosurgery. There was no obvious adverse impact of the HIV disease on the anesthetic outcome, no obvious clinical evidence of post-surgery worsening of the HIV disease, and no instance of HIV transmission in our patients.
  
  
  CONCLUSIONS
  A goodunderstanding of the HIV disease and its perioperative implications during neurosurgery helps in better patient management and enables a safe outcome.
authors.affiliation: Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India.
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Agarwal
authors.affiliation: Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India.
authors.forename: Pragati
authors.initials: P
authors.lastname: Ganjoo
authors.affiliation: Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India.
authors.forename: Upendra
authors.initials: U
authors.lastname: Hansda
authors.affiliation: Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India.
authors.forename: Megha U
authors.initials: MU
authors.lastname: Sharma
authors.affiliation: Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Tandon
authors.affiliation: Department of Neurosurgery, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India.
authors.forename: Daljit
authors.initials: D
authors.lastname: Singh
keywords: Anesthetic considerations; anesthetic outcome; human immunodeficiency virus; neurosurgery; perioperative concerns