HIV and anesthesia

HIV is a newly recognized microbe that was not discovered until the 1980s [1]. This compares, for example, with centuries of concern for smallpox. HIV infection is responsible for AIDS, a disease that crept quietly and unnoticed into our nation’s health sometime in the late 1970s [2]. The first reported description, in 1981 [3], went virtually unnoticed by most physicians but was, in fact, the herald for the greatest health crisis of the late twentieth and early twenty-first century. On a global basis, 40 million people (34–46 million) were living with HIV/AIDS by the end of 2003 with 5 million new cases that year (Fig. 1) [4,5]. Although 4.2 million (3.6–4.8 million) of the newly infected persons were adults, as many as 810,000 were children under the age of 15. In sub-Saharan Africa, the AIDS epidemic appears to rival the Bubonic plague, or ‘‘pestilence,’’ as it was referred to in England circa 1348–1349. This was later referred to as the ‘‘Black Death’’ and it has been called the greatest biomedical disaster in European history [2,6]. It is estimated that the pestilence caused the deaths of 20 million people, or 30% to 50% of the total population in many parts of Europe. In some regions of Africa, the AIDS epidemic may be approaching the magnitude of this historic catastrophe (Table 1). In the United States and Western Europe, the epidemic, while tragically real, does not approach the sub-Saharan experience. However, most anesthesiologists will care for HIV-positive patients at some time, regardless of where they practice. They will need to learn about a disease that ‘‘didn’t exist’’ when many of them were trained. Certainly, the last 6 to 10 years have seen great advancement in the understanding and successful treatment and therapy of this disease. This has meant that patients are living much longer and will need advanced medical and surgical care. It has been estimated that 20% to 25% of HIV-positive patients will require surgery during their illness