Investigation of potential HIV transmission to the patients of an HIV-infected surgeon.
OBJECTIVE
To ascertain if a surgeon infected with the human immunodeficiency virus (HIV) transmitted HIV to patients during invasive surgical procedures.


METHODS
Survey of patients and acquired immunodeficiency syndrome (AIDS) case registries, and laboratory analysis of nucleotide sequence data.


METHODS
One surgeon's private and institutional practices within one academic referral hospital.


METHODS
A total of 1131 persons identified in hospital databases who underwent invasive surgical procedures from 1984 through 1990 and for whom the surgeon was listed as the admitting or operating surgeon.


METHODS
Patients presumed to be living were surveyed by mailed questionnaire. The AIDS case registries were reviewed for all patients having undergone invasive procedures and death certificates were obtained. Person-hours of surgery during which exposure might have occurred were calculated for surgical procedures.


RESULTS
Of 1131 patients, 101 were dead, 119 had no address, 413 had test results known, and 498 did not respond to the questionnaire. No study patient name was found in reported AIDS case registries. One newly detected, HIV-seropositive patient was determined (through nucleotide sequencing) to have been most probably infected in 1985 during a transfusion. There was no HIV transmission in 369 person-hours of surgical exposure, indicating that HIV transmission to patients is unlikely to occur more frequently than once per 1000 person-hours of surgical exposure.


CONCLUSIONS
If study validity and resources permit, investigation of publicly disclosed, HIV-infected health care workers whose practices involve invasive procedures should be pursued. The risk of HIV transmission during surgery may be so small that it will be quantified only by pooling data from multiple, methodologically similar investigations.
Rogers
A S
AS
AIDS Administration, Maryland State Department of Health and Mental Hygiene, Baltimore.
Froggatt
J W
JW
Townsend
T
T
Gordon
T
T
Brown
A J
AJ
Holmes
E C
EC
Zhang
L Q
LQ
Moses
H
H
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology; D015142:Baltimore / Q000453:epidemiology; D016358:Contact Tracing; D003625:Data Collection; D005554:Forensic Medicine / Q000191:economics / Q000379:methods*; D013502:General Surgery; D015658:HIV Infections / Q000453:epidemiology / Q000235:genetics / Q000635:transmission*; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D008396:Maryland / Q000453:epidemiology; D010361:Patients / Q000706:statistics & numerical data*; D016133:Polymerase Chain Reaction; D012042:Registries; D012306:Risk; D017422:Sequence Analysis, DNA; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data