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Investigation of Patients Treated by an HIV-Infected Cardiothoracic Surgeon

Posted Jan 11 2009 2:53pm

Transmission of human immunodeficiency virus (HIV) from an infected health-care worker to patients is rare (1), with the greatest potential for occurrence during exposure-prone, invasive surgical procedures in which the blood of the health-care worker might come into contact with patients’ blood or mucous membranes. When a surgeon is discovered to have HIV infection, a decision must be made about notification of patients, but only limited data are available to guide decision-making. Such notifications generally are decided upon on a case-by-case basis, taking into account such factors as the nature of the procedures performed, the infection-control knowledge and practices of the infected surgeon, the presumed likelihood of transmission, and available resources (2). This report describes the case of a cardiothoracic surgeon in Israel specializing in open-heart procedures (coronary artery bypass grafting and valve surgery) who was found to be HIV positive in January 2007 during evaluation for fever of recent onset. The duration of infection was unknown. A lookback investigation of patients operated on by the infected surgeon during the preceding 10 years was conducted under the auspices of the Israel Ministry of Health to determine whether any surgeon-to-patient HIV transmission had occurred. Of 1,669 patients identified, 545 (33%) underwent serologic testing for HIV antibody. All results were negative. A Ministry-appointed panel of experts delineated conditions under which the surgeon could resume work. The results of this investigation add to previously published data indicating a low risk for provider-to-patient HIV transmission.

The surgeon had been in practice for more than 2 decades and performed approximately 150 procedures per year. The surgeon reported no risk factors for HIV and had no available record of prior HIV testing. The surgeon was aware of and reportedly compliant with institutional infection-control guidelines and did not report any incidents of blood exposures that might have placed patients at risk.

At the time of diagnosis, the surgeon’s CD4 T-cell count was 49 cells/µL, and HIV RNA was >100,000 copies/mL. The surgeon had a protective serum level of hepatitis B surface antibody and was seronegative for hepatitis C virus (HCV) antibody.

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