Follow-up studies

Almost all follow-up studies of surgeons known to be HIV–positive have failed to find any cases of HIV infection from surgeons, despite fears that the surgeons might have cut themselves during operations and thus infected their patients.^{1 2 3} Up to several hundred patients have been followed up in some cases, both in the USA and in the UK.

Two studies provide evidence from extensive follow-up programmes of the minimal risk associated with invasive procedures.

In June 1991 an orthopaedic surgeon who had been practising in the same community in New Hampshire, USA, for 16 years was found to be HIV-positive. He had probably been infected before 1979. As has been found for other orthopaedic surgeons, he had sustained quite frequent minor skin punctures, at least once a month. Following such injuries he used to remove and discard the instrument which had caused the injury immediately, to prevent it from subsequently coming into contact with the patient. He would also change his gloves. When injuries were caused by tiny fragments of bone, the patient's wound would immediately be washed with an antiseptic solution. The surgeon and theatre nurses were interviewed and none recalled any occasion when a patient was thought to have been exposed to the surgeon's blood.

Letters were sent to 2317 former patients, who had undergone 2652 invasive procedures between January 1978 and June 1991. 1174 underwent HIV testing, all of whom were negative. None of the non-respondents or untested patients could be established to have AIDS through other medical records.

Despite practising for many years in a surgical speciality likely to have a higher than average risk of patient exposure, the surgeon was not found to have infected any patients.⁴ This case suggests that when careful hygiene procedures are followed in situations where a risk exists, infection does not seem to occur.

A surgeon in Maryland, USA, died in November 1990, after which local newspapers demanded disclosure of the fact that he had died of AIDS. A trace-back exercise through his hospital followed, and 413 of the 1012 patients known to have undergone invasive procedures were tested. One seropositive patient was subsequently identified. This person had previously received a blood transfusion from a donor who was traced and found to be HIV-positive, and who had probably already been infected at the time of the donation. The genetic sequences of viruses from the patient, the surgeon and the blood donor were compared. That from the patient was closely related to the blood donor's, but not to the surgeon's.⁵ Researchers decided that the surgeon could not have been the source of infection.