HIV+ Working Surgeon
posted: 14/01/2009
An HIV-positive surgeon in Israel is being allowed to continue working. He or she is taking HIV treatment and has an undetectable viral load. The Israelis have effectively issued a statement, rather like the Swiss statement we have been reporting on over the last year. Both statements are about how effective HIV treatment can reduce infectivity to close to zero.
simple precautions are enough
The Israeli Ministry of Health has decided that the surgeon with HIV who is receiving antiretroviral treatment may return to carrying out invasive surgical procedures, providing that he or she maintains an undetectable viral load, follows infection control procedures and uses two layers of surgical gloves when operating.
Time for UK HIV+ healthcare workers ban to be reviewed
Healthcare workers with HIV are routinely banned from surgical procedures of any kind, even very minor ones such as stitching wounds. This affects some doctors, midwives, some nurses, dentists, and some ambulance staff, among others.
The Israeli decision is increasing the pressure on bodies regulating UK and other countries' healthcare employment to review their guidance on healthcare workers with HIV engaging in exposure-prone, invasive procedures.
In the United Kingdom, for example, the General Medical Council and the General Dental Council require that HIV-positive healthcare workers desist from carrying out exposure-prone procedures – anything that involves cutting, suturing, use of needles or delivery of babies using forceps or suction, and almost all dental work, – and all healthcare workers recruited to the National Health Service who will be carrying out these types of procedures are tested for HIV. Many healthcare workers have been forced to retire or change careers as a result of the guidance, including several in the NorthWest of England.
The Israeli statement is the first official acknowledgement that HIV treatment reduces the risk of bloodborne HIV transmission to such low levels that a doctor, dentist, nurse or midwife can continue working.
It could help reduce stigma for people with HIV, as long as media storms about fears of HIV transmission from healthcare workers can be avoided.
NAM's HIV Treatment Update in August/September took a detailed look at whether healthcare workers should be allowed to carry out surgical procedures.
HIV is present in potentially infectious quantities in blood, semen, vaginal fluids and breastmilk and, as a result, HIV can be passed on through injecting drug use, unprotected sex, and from a mother to her baby.
It’s not inevitable that a person exposed to HIV will become infected with the virus. One of the factors that affects this risk is the viral load of the person with HIV. HIV treatment lowers viral load both in blood and genital fluids.
There’s recently been a lot of debate about the infectiousness of people taking HIV treatment who have an undetectable viral load.
Swiss doctors kick-started the debate about a year ago. In a statement, they said that a person taking HIV treatment, who’d had an undetectable viral load for at least six months, who took all their medication and who didn’t have a sexually transmitted infection, was not infectious to their heterosexual partners.
The current consensus seems to be that HIV treatment, and all the Swiss conditions, reduces the risk of sexual transmission, but that a small risk may still be present.
Full report in the USA's Morbidity and Mortality Weekly Report
Some further details are in the aidsmap report
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