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Ban Lifted For Nhs Staff With Hiv

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http://www.bbc.co.uk/news/health-23698991

The government is to lift a ban that stops healthcare staff with HIV performing certain medical procedures.

Healthcare staff in England, Wales and Scotland having HIV treatment will be able to take part in all tasks, including surgery and dentistry.

England's chief medical officer, Prof Dame Sally Davies, said it was time to scrap "outdated rules".

...

She told the BBC that patients controlling their infection with medication were not a danger: "The risk is negligible and I would accept that for myself, for my family and I think it's right."

Is this reasonable, if they are going to be allowed to do these procedures should the patient be informed of the persons HIV status prior to any medical procedure being carried out.

I'm sure I heard this morning saying the risk of transmission was 1 in 5m.

Or is the risk that negligible informing patients of their current status isn't required?

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Or is the risk that negligible informing patients of the career status isn't required?

I assume that's a Freudian slip. Informing patients that the surgeon's on a performance improvement plan might not go down well.

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I assume that's a Freudian slip. Informing patients that the surgeon's on a performance improvement plan might not go down well.

Yep meant current, rather than career. Although imagine the patients face hi I'm HIV positive and the last 3 patients I've performed this procedure on have all died within 48 hours. Would you mind signing the consent form!

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Provided patients are told and have a choice. There is no way I'd want someone with HIV anywhere near my major operation. Why take the risk?

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So there's slightly more chance of catching HIV from your surgeon (if they are positive) than of winning the lottery. Hmm :unsure: .

On the other hand, I would imagine that the number of HIV positive surgeons is probably vanishingly small, and most people don't have surgery twice a week. So I can't say I'm that worried :D .

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As long as they are taking the drugs (and the drugs are working), then the amount of HIV in the bloodstream will be very very low. Transmission mainly only happens when the virus levels are very high, as happens 6-8 weeks after infection or when AIDS sets in. [if the drugs are working, then HIV only stays in the body by hiding in pockets where the drugs cant reach]

I cant imagine a surgeon operating when they have AIDS and just after infection, they wouldnt know about it anyway. Though, maybe just to be safe, they should put some upper limit on the HIV count.

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Considering all the other things you can die from in NHS hospitals, it's probably not a big deal.

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Considering all the other things you can die from in NHS hospitals, it's probably not a big deal.

As you say, a lot of people in hospital are unwell, and might have something catchy!

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As long as they are taking the drugs (and the drugs are working), then the amount of HIV in the bloodstream will be very very low. Transmission mainly only happens when the virus levels are very high, as happens 6-8 weeks after infection or when AIDS sets in. [if the drugs are working, then HIV only stays in the body by hiding in pockets where the drugs cant reach]

It is a planned requirement that any healthcare worker in this position would have to provide regular up-to-date proof that they are taking the medication regularly and that regular blood tests continue to be negative for HIV virus (i.e. undetectable HIV levels). A test which shows a detectable level of HIV will mean that they must stop work immediately.

The safety of this is not known, but it is well known that the risk of blood-borne transmission is related to the virus load (i.e. number of virus particles per ml of blood). A good response to drugs will result in undetectable viral load (i.e. no detectable virus in blood). It is expected that the risk of transmission in this state is extremely low, but there are no large studies which have looked at blood-borne transmission and found a positive result.

There are 9 known cases of health-care worker to patient HIV transmission (6 from 1 dentist). In all cases, the HCW was not on treatment and had advanced HIV disease, presumably with high viral loads. The dentist had performed over 1100 "high-risk" procedures during his infected period, suggesting that even for "High risk" procedure, and advanced HIV disease, the risk of infection is less than 1%. In all the other cases, only 1 patient out of many hundreds of "at risk" was infected by each HCW with advanced disease.

It is known that the risk of sexual transmission of HIV when blood HIV levels are zero is very low, but not zero (estimated risk 0.1% per year for a sexually active couple not using barrier contraception, where the male partner is HIV positive but with undetectable blood HIV). However, it is also known that even though the drugs may reduce blood HIV to zero, they don't reduce sexual secretion HIV levels to zero (possibly because the drugs cannot reach these areas).

There have been a variety of attempts to quantify the risk of allowing infected surgeons to operate, using statistical extrapolations; these are subject to considerable uncertainty, not least because the risk of HIV tranmsission by blood is not well known in the context of treatment (if it occurs it's too rare to get good statistics). Estimates range from 1 case of tranmsission in the UK every 10 years, to 1 case every 300 years (if all infected HCWs were allowed to continue operating as normal). There are about 2 million operations performed each year in the NHS, so the risk could be estimated as between 1 in 20 million and 1 in 600 million per operation.

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It is known that the risk of sexual transmission of HIV when blood HIV levels are zero is very low, but not zero (estimated risk 0.1% per year for a sexually active couple not using barrier contraception, where the male partner is HIV positive but with undetectable blood HIV). However, it is also known that even though the drugs may reduce blood HIV to zero, they don't reduce sexual secretion HIV levels to zero (possibly because the drugs cannot reach these areas).

Out of interest what is it the other way if the female is infected?

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Come on! Not many surgeons have HIV! I would be more worried if they left a golf club inside me! :unsure:

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Out of interest what is it the other way if the female is infected?

Thought to be about the same as for M-to-F lanigaV intercourse.

There is a larger body of statistics for people with HIV, but not necessarily with undetectable virus (i.e. less good response to treatment, or on earlier generations of treatments). These suggests that M-to-F is higher risk than F-to-M but not drastically. The risk for M-to-any lanA intercourse is hugely higher (something like 20-25x).

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