Surgeons Undergo Test for AIDS Virus : Medicine: Orthopedic doctors participate in a voluntary screening at convention. A positive outcome could virtually end a practitioner’s career.
The middle-aged man emerged from a large white tent opposite the Anaheim Convention Center. “It was very scary in there. I don’t want to talk about it,” he said Wednesday as he ducked his head and hurried away.
The worried man--one of 9,000 doctors attending the annual meeting of the American Academy of Orthopaedic Surgeons--had just had his blood tested for the AIDS virus.
Results of the test, available in the next 48 hours, could determine whether he continues to work as a surgeon or virtually gives up his profession.
According to guidelines adopted Wednesday by the academy’s board of directors, orthopedic surgeons who test positive for the deadly virus may risk infecting their patients and so should avoid “invasive surgical procedures.” Instead, the board recommended, they should “consider carefully the attributes of an exclusively office-based practice.”
Over the next four days, academy leaders estimate, as many as 3,000 surgeons will voluntarily report to the tent for confidential tests--all part of a unique research project planned by their organization and the National Centers for Disease Control.
The goal: to learn what percentage of the nation’s surgeons are infected with the AIDS virus. “It’s an important thing to do because we don’t know how at risk we are,” said Dr. Daniel R. Benson, a UC Davis professor of orthopedic surgery who chairs the academy’s HIV Task Force.
From Wednesday through Sunday, in the tent across the street from the surgeons’ conference, 50 people hired by the CDC will be standing by, ready to draw blood and talk to surgeons about the personal impact of AIDS. Also shown regularly in the tent is a 15-minute academy videotape on precautions that surgeons can take--from welder-type goggles to waterproof surgical gowns--to prevent exposure to the AIDS virus.
Although surgeons will learn their infection status in confidence about 48 hours after their blood is drawn, overall test results will not be available for several months, CDC officials said.
The CDC has not done testing on this scale since the early 1970s when technology first became available for studying the prevalence of the hepatitis B virus, said Dr. Mary Chamberland, chief of the CDC’s epidemiological studies unit. At that time--before introduction of a vaccine against that viral infection--tests run at annual meetings for doctors, surgeons and dentists found that 25% of those participating were infected with hepatitis B.
Chamberland noted that she was not expecting that high a rate for infection with the AIDS virus. Previous tests--in the military and among dentists--indicate that about one health worker in 1,000 may have become infected at work with the virus that causes acquired immune deficiency syndrome.
But orthopedic surgeons are of special concern, Chamberland noted, because they have an unusually high risk for “needle sticks, scalpel cuts, exposure to blood on the job.” In a recent CDC study of four hospitals, orthopedic, trauma and gynecological surgeons received some sort of injury in 2.5% of their operations.
Added academy spokesman Alvin Nagelberg: “There’s always the danger of doctors getting punctured and the infected physician transmitting the disease to the patient. Or the patient to the physician.”
Those concerns have heightened since the CDC last fall revealed that a Florida dentist who died of AIDS had infected three of his patients. Also, Nagelberg noted, Johns Hopkins Hospital in Baltimore recently confirmed that a well-known breast surgeon there had died of AIDS and the hospital offered free testing to 1,800 of his former patients.
AIDS has been an issue of growing concern among orthopedic surgeons for at least the last four years, since the academy’s HIV Task Force was formed, Benson said. “I’m sure I’ve operated on 30 to 40 patients who were HIV positive,” he noted.
Benson said surgeons should inform patients if they are infected with the AIDS virus. At the urging of Benson’s task force, the academy’s board on Wednesday adopted a nine-point “advisory statement” for surgeons who test positive for the HIV virus.
The academy’s statement on HIV-infected surgeons appears to be stronger than a policy adopted by the American Medical Assn. earlier this year. In a Jan. 17 statement, the AMA said that HIV-infected physicians “have an ethical obligation not to engage in any professional activity which has an identifiable risk of transmission of the infection to the patient.”
Also on that date, the American Dental Assn. recommended that “HIV-infected dentists should refrain from performing invasive procedures.”
Explaining the stance of the orthopedic surgeons, Dr. John B. McGinty, president of the academy, said, “The academy believes that the health of the patient is of paramount importance.”
The academy’s board said that orthopedic surgeons “have a responsibility to know their own HIV status through periodic HIV testing.” It recommended that an infected surgeon “should not perform invasive surgical procedures” except in limited situations.
These would include receiving permission from a patient to perform the surgery once the infected surgeon has notified a patient of his status.
Also, the academy said, in an emergency when no other physician is available, an infected physician should be able to perform “invasive procedures” if the patient or his family is notified that the physician is positive for the HIV virus.
Still, the statement said, “the academy recommends that a HIV-infected orthopedic surgeon consider carefully the attributes of an exclusively office-based practice where less risk of HIV transmission would exist.”
