Israeli surgeon allowed to practise

In 2007 an Israeli surgeon specialising in open-heart procedures was found to be HIV positive, and an extensive look-back exercise was conducted in which 545 patients were tested.¹

1494 patients who had received cardiothoracic surgery at the hands of the surgeon in the previous ten years were contacted; 545 provided blood samples for testing. (Of the remainder who did not agree to testing, none were listed in the national HIV registry.) None of those tested were infected with HIV, despite the fact that the surgeon had a high viral load (above 100,000 copies/ml) and a very low CD4 count at the time of diagnosis, indicating that the surgeon had been infected with HIV for some years. The surgeon did not report any incidents when blood exposure could have placed patients at risk.

This led the Israeli health ministry to decide that the surgeon could return to work, which was the first time that a public health body has admitted that an HIV-positive healthcare worker has been cleared to carry out invasive surgical procedures since the introduction of antiretroviral therapy.

Their decision specified that:

• The surgeon could return to work; his or her infection control compliance would be closely monitored. In particular the surgeon would wear two pairs of surgical gloves.
• The surgeon must maintain good adherence and attend for regular monitoring to ensure that an undetectable viral load and a CD4 count above 200 cells/mm³ is maintained.
• Prospective patients of the surgeon would not need to be notified of the surgeon’s HIV infection because there is an extremely low risk of HIV transmission if these conditions are met.

The judgement that antiretroviral therapy and viral suppression are risk-reduction measures for HIV transmission echoes the Swiss Federal AIDS Commission's statement in January 2008, which stated that individuals with undetectable viral load on treatment cannot transmit HIV.²