Human immunodeficiency virus and the airway

Abstract

Seventy-five to one hundred per cent of patients with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) have a head and neck manifestation. These manifestations may impact on anaesthetic management, but more importantly often allow the anaesthetist to diagnose the disease before the patient or the surgeon may be aware of possible contagion. Immune compromise, arising from the onslaught of CD4 cells, results in severe infections (overwhelming fungal and bacterial) and cancers. Vasculitides also become prevalent, resulting in bizarre unpredictable manifestations such as aneurysmal formation in the vessels of young patients, and bleeding or clotting diathesis in all ages. The World Health Organization classification, based on specific pathology, allows for accurate clinical staging of the disease. Grave concerns for the anaesthetist are the constant threat of needle-stick injuries and the contraction of tuberculosis, which is becoming resistant to treatment. It should be noted that many of the signs and symptoms described herein will be attenuated or absent once the patient is on antiretroviral therapy (ART). However, in South Africa, only 500 000 of an estimated five million patients infected with HIV are receiving ART. Therefore, it is still of value to recognise and understand the pathology caused by degrees of immune compromise from HIV/AIDS. Ironically, ART may impact on the airway owing to immune reconstitution inflammatory syndrome and lipodystrophy.