I have just been diagnosed with aortic valve stenosis, and an aneurysm on my ascending aorta of ~5 cm. At the same time, I was diagnosed HIV+ -- CD4 count of 420, and viral load of ~60,000.

How do the two diagnoses interact? Should I wait for valve and aorta replacement surgery until my viral load is undetectable? What are the risks of doing the heart surgery before the HIV is under control?

First, there is no contraindication to having this surgery with being HIV infected. The likelihood of having infectious complications is usually no greater. If your heart condition is stable (i.e., doesn't need urgent repair), it might be best to start HIV meds and get the virus under control first. That would require about 3-4 months to get your viral load to undetectable. There are likely heart medications and blood thinners you will be taking after surgery, and for a long time after. Several of the HIV medications will interact with these medications, but there are HIV medications which can be prescribed that will have little to no impact on these medications.