Q: I am a transgender person with HIV. I am healthy and on medication. I am really having a hard time finding a cosmetic surgeon that is willing to do surgery on me, perhaps because they feel uncomfortable about my HIV or are unsure if I am more prone to infection afterwards. I have read that you have performed plastic surgery uneventfully with people who have HIV. I hope you can help me with my questions:
1. Any advice with the anesthesia ( I read a few stories that it could interfere with medication and that could lead to coma). I am on a medication called Atripla.
2. What is the best CD4 count I would be reasonable to continue with surgery?
3. Any suggestions with antibiotics and anti inflammatory medication to avoid infection and promote good healing?
Dr, your advice and help would be much more appreciated. I hope to hear from you very soon.
A: There is a growing body of evidence that HIV patients are not at increased risk for infection or wound healing problems from surgery in general and plastic surgery in particular. Recent published studies in plastic surgery dispel this myth, provided that the patient has good CD4 counts and is not an immunosuppressive medication. One study has shown that there may be an increased risk when plastic surgery is done through the mouth as opposed to the skin. But it can also be said that such may apply to the general population as well. In my Indianapolis plastic surgery experience, I have not seen any increased problems operating on HIV patients for either cosmetic or reconstructive plastic surgery. To answer your specific questions:
1) Atripla is a multiclass retroviral drug commonly used in the treatment of HIV. It has no known adverse effects on wound healing which is the most important consideration in surgical outcome. From an anesthesia standpoint, there is a drug interaction with Versed, a common drug in the anesthesiologist’s pharmaceutical cornucopia. This drug is mainly used to treat anxiety immediately before surgery done on an intravenous basis. It is not absolutely necessary to use it for general anesthesia as other drug options exist.
2) Patients with CD4 counts greater than 200 and low viral loads have surgical risks that are similar to the general population. There is no evidence to support the historic contention that they have poor or compromised wound healing. Increased surgical risks are in those patients whose CD4 counts are less than 200 or have viral loads greater than 10,000.
3) The usual use of antibiotics and pain medications, as is usually done on any other patient, is all that is needed. No extra dosing of antibiotics or prolonged duration of antibiotic use has any proven benefit on reduced infection risk.
Dr. Barry Eppley