Hiv Poz Surgeon Cleared To Return To Surgery

An HIV-infected cardiothoracic surgeon in Tel Aviv, Israel has been cleared to resume operating without restrictions after a 10-year lookback investigation found no spread of the disease to patients, reported Israeli and CDC investigators.

The only stipulations for the surgeon will be to maintain an undetectable level of HIV RNA in his blood, as well as a CD4 T cell count above 200 per microliter, said Mitchell J. Schwaber, M.D., of the Israel Ministry of Health, and CDC colleagues, in the Jan. 9 issue of Morbidity and Mortality Weekly Report.

There are no restrictions on the types of procedures he can perform. Because of the extremely small chance of transmission with these precautions and double-gloving, the panel did not require notification of patients of the surgeon's HIV status.

The lookback investigation was started when the unnamed surgeon, a veteran of two decades in the OR, was diagnosed in January 2007.

At diagnosis, he had a CD4 cell count of 49 and an HIV RNA level of more than 100,000. He has since started antiretroviral therapy and has a CD4 count above 200 and undetectable viral levels.

The lookback investigation identified 1,669 patients, of whom 121 had died and 54 could not be found. Of the remaining 1,494 patients, 545 agreed to be tested for HIV.

All samples submitted were negative for the virus, the investigators found.

An expert panel named by the Israeli health ministry said the surgeon could resume work, provided there was instruction by infection-control personnel at the surgeon's hospital regarding safe practices, including:
adherence to standard precautions and hand hygiene requirements including double gloving during surgery and immediate reporting of any cuts in gloves or fingersticks.

The surgeon was also required to have a check-up at three-month intervals and stick to his antiretroviral regimen, as well as keeping his immune cells up and his HIV undetectable.Courtesy MedpageToday.