Update on antiretrovirals

Abstract

According to the WHO and UNAIDS, 36.7 million people were living with HIV worldwide at the end of 2016. About 1.8 million people were newly infected that year and 1 million died of HIV-related causes.¹ South Africa has the largest HIV epidemic in the world, with an estimated 12% of the total population infected with the disease.² Statistics show that South Africa had approximately 270 000 new HIV infections and just over 110 000 AIDS-related deaths in 2016. Over 7 million people were living with HIV in 2017, and of these, about 56% were accessing antiretroviral therapy.¹ With such a high infection rate in South Africa and with the advancements in the management of the disease,³ a thorough understanding of this multi-systemic disease process as well as the antiretroviral treatment is paramount for anaesthesia. Antiretroviral treatment has led to the increase in life expectancy of those infected⁴ and anaesthetists see many patients presenting for surgeries at all stages of the disease.⁵ With more than 30 ARV drugs now available as either single or combination tablets, the drug interactions, side-effects and anaesthetic implications need to be understood in detail.⁶