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A 50-year-old man with stable HIV infection (undetectable viral load, CD4 count >500 cells/mm3) is referred for routine screening colonoscopy. However, he is concerned that he will not get sufficient anesthesia for the procedure because his partner, who is also HIV-positive and on the same antiretroviral regimen as he is (tenofovir/FTC and ritonavir-boosted atazanavir), underwent the procedure last year and did not receive the usual sedation (midazolam plus either meperidine or fentanyl) because of potential drug–drug interactions with his antiretrovirals. The patient also tells you that one of his friends was told to stop his HIV therapy the day of the procedure, which then allowed the usual sedatives to be used.
What is the proper approach…