Emtricitabine/Tenofovir Does NOT Need to Be Held Before Surgery/Anesthesia
Antiretroviral medications, including emtricitabine/tenofovir, should be continued on schedule as much as possible before and after surgery to maintain viral suppression and prevent resistance development. 1
Perioperative Management of Antiretroviral Therapy
Continue Therapy Through the Perioperative Period
Antiretroviral drugs should be maintained throughout the surgical period without interruption to provide maximal therapeutic effect and minimize the risk of viral resistance development 1
Oral medications, including emtricitabine/tenofovir, may be continued preoperatively with sips of water even during standard fasting protocols 1
For medications requiring food for absorption, liquid dietary supplements can be used, though consultation with the anesthesiologist is recommended 1
Critical Principle: Avoid Selective Drug Interruption
If antiretroviral therapy must be temporarily interrupted in the peripartum or perioperative period, all drugs should be stopped and reinstituted simultaneously to minimize resistance development 1
Never discontinue individual components of a combination regimen while continuing others, as this creates functional monotherapy and promotes resistance 1
Rationale for Continuation
Maintaining Viral Suppression
Emtricitabine and tenofovir have favorable pharmacokinetic profiles with plasma and intracellular half-lives suitable for once-daily dosing 2
Interrupting therapy risks viral rebound, which can occur rapidly and compromise long-term treatment success 3
Prevention of Resistance
The active metabolites (FTC-TP and TFV-DP) act as chain terminators to proviral DNA synthesis, and maintaining therapeutic levels prevents resistance mutations 2
Treatment interruptions, particularly selective interruptions, significantly increase the risk of developing resistance mutations such as M184V or K65R 1, 2
Practical Perioperative Considerations
Preoperative Fasting
Standard preoperative fasting guidelines allow clear fluids up to 2 hours and solids up to 6 hours prior to anesthesia induction 1
Emtricitabine/tenofovir can be taken with sips of water during the fasting period 1
Postoperative Resumption
Resume the regular dosing schedule as soon as oral intake is tolerated postoperatively 1
There is no need for dose adjustment or bridging strategies, unlike anticoagulants which require specific perioperative management 1
Safety Profile
Emtricitabine/tenofovir combinations demonstrate excellent tolerability with low rates of treatment discontinuation due to adverse events (1-2% in clinical trials) 4, 3
No specific anesthetic interactions or perioperative complications have been documented with these agents 5
The drugs are not metabolized by CYP450 enzymes, eliminating concerns about drug-drug interactions with anesthetic agents 2
Common Pitfalls to Avoid
Do not hold antiretroviral therapy "just to be safe" – this approach increases morbidity through viral rebound and resistance risk 1
Do not confuse antiretroviral management with anticoagulant management – these are entirely different drug classes requiring opposite approaches 1
Do not restart only some components of the regimen if interruption occurred – restart all simultaneously 1