Volume 201 - Issue 7
Time to end the ban on HIV-positive proceduralists and dentists
Author: Sean R Atkinson
Med J Aust 2014; 201 (7): 384. || doi: 10.5694/mja14.01031
Published online: 6 October 2014
Published online: 6 October 2014
A lack of demonstrable harms means HIV professionals should be allowed to practise
To the Editor: This year, the ban on HIV-positive surgeons and dentists practising in the United Kingdom was removed on the provision that they are clinically well, are being treated, and have an undetectable viral load.1 This development aligns the UK with over 20 other countries. Australia is lagging behind other more progressive countries on this issue.2
During the height of the HIV epidemic in the early 1990s, there were no HIV transmissions among 22 171 patients exposed to pre-antiretroviral (ART)-era HIV-positive doctors and dentists during invasive operations.3
There have been only 10 published case reports indicating probable transmission from a proceduralist to patients since HIV was first reported.4 The current risk estimate is 1 in 1 672 000.2 No cases of inadvertent transmission have been reported in the literature from countries that allow HIV-positive proceduralists.2
ART is vital for reducing the risk of transmission. Extrapolating from the ongoing PARTNER study, there have been no transmissions between serodiscordant couples who have regular, unprotected, high-risk sex if the positive partner is receiving ART and virally suppressed 2 years into the study.5 The risk during procedures by HIV-positive virally suppressed proceduralists, with the use of standard universal precautions (such as gloves and sterile equipment), would likely be extremely low.
There are two major problems with a blanket ban on HIV-positive proceduralists. First, those facing a career-ending outcome of a test are likely to avoid being tested after an initial negative test result. Second, the wrong message is sent to the public that people with HIV are highly infectious and are somehow dangerous (despite treatment). Lifting the ban would lead to greater incentives for proceduralists to be regularly tested for HIV, leading to better outcomes for them and their patients. This is important as many infected individuals transmit the virus when they are seroconverting and are unaware of their diagnosis.6 Furthermore, postexposure prophylaxis could also be available to patients after possible exposure during a procedure by following occupational exposure guidelines.
It is time for Australia to align with other progressive nations and end theabsolute ban on HIV-positive proceduralists. The risk of transmission from them, when treated for HIV and using standard precautions, is likely to be negligible.
Competing interests
No relevant disclosures.
References
- Ban lifted on HIV-positive doctors practising surgery. (news). London: British Medical Association, 2013. http://bma.org.uk/news-views-analysis/news/2013/august/ban-lifted-on-hiv-positive-doctors-practising-surgery (accessed Sep 2014).
- Ma R. Discrimination against doctors with HIV must end. BMJ 2012; 344: e3440. _Ref398095800
- Robert LM, Chamberland ME, Cleveland JL, et al. Investigations of patients of healthcare workers infected with HIV: The Centers for Disease Control and Prevention database. Ann Intern Med 1995; 122: 653-657. _Ref398096332
- Centers for Disease Control and Prevention. Investigation of patients treated by an HIV-infected cardiothoracic surgeon — Israel, 2007. MMWR Morb Mortal Wkly Rep 2009; 57: 1413-1415. _Ref398712927
- Rodger A, Bruun T, Cambiano V, et al. HIV transmission risk through condomless sex if HIV+ partner on suppressive ART: PARTNER study. 21st Conference on Retroviruses and Opportunistic Infections; 2014 Mar 3-6; Boston, Mass, US; abstract 153LB. _Ref398097096
- Chibo D, Kaye M, Birch C. HIV transmissions during seroconversion contribute significantly to new infections in men who have sex with men in Australia. AIDS Res Hum Retroviruses 2012; 28: 460-464. _Ref398097483