AIDS, Emergency Operations, and Infection Control

Abstract

Acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) may turn out to be the largest lethal epidemic of infection ever. The estimated global number of HIV-infected adults in 1993 was 13 million, with projections of up to 40 million by the year 2000. Human immunodeficiency virus infections and AIDS are relevant to surgeons with respect to the surgical management of AIDS patients in general, the treatment of the increasingly long list of surgical complications specific to AIDS patients in particular, and the risks of patient-to-surgeon and surgeon-to-patient HIV transmission. Because of migration of individuals and populations throughout the world, even surgeons practicing in relatively unaffected regions should be familiar with the potential surgical implications of AIDS. Ethical considerations arise, as well. Are surgeons obliged to operate on HIV-positive or AIDS patients? Some surgeons adhere strictly to the Hippocratic Oath, whereas others reserve the right to be selective on whom they operate, except in emergencies. Other common ethical considerations in the AIDS patient are similar to those arising in the terminal cancer case: whether to operate or not; whether to provide advanced support such as total parenteral nutrition or hemodialysis. Answers are not simple and require close collaboration between the surgeon, the AIDS specialist, and involved members of other specialties. Emergency operations become necessary to treat AIDS independent disease such as acute cholecystitis and appendicitis or AIDS-related life-threatening conditions such as gastrointestinal bleeding, obstruction, perforation, or ischemia complicating Kaposi's sarcoma, lymphoma, and cytomegalovirus or disseminated nontuberculous mycobacterial infections. Delays and errors in diagnosis are frequent. Poor nutritional state with weight loss, low serum albumin, and leukocyte count prevails in most patients requiring emergency operations and account for a high mortality. By applying solid judgment and selecting management appropriately, the surgeon has the ability to prolong life and to improve the quality of life for these unfortunate patients, and to do so with extremely minimal risk to himself and his team.

Elective Spinal Surgery in Asymptomatic HIV-Seropositive Persons

“…In addition to ethical obligations, there are legal ramifications for refusal treat HIV-positive persons. 21,22 The Americans With Disabilities Act, without commenting on a specific condition, sets forth legal obligations regarding treatment of "handicap" persons. 23,24 The ADA provides federal standards for antidiscrimination laws.…”

Current practice in the management of high-risk orthopaedic trauma patients in Scotland

“…14,15 The risk of transmission of hepatitis B + C following a hollow needle injury is approximately 30 and 1.8%, respectively, while the risk of acquiring HIV is 0.3%. 19,20 The technique of double gloving has been shown to reduce the risk of contamination of the surgeon's hands in multiple studies (either due to tears or perforations). 6,18 Based on this, Nystrom and Wittmann 13 have calculated the risk of a surgeon operating on HIV patients actually contracting HIV from hollow needles whilst double gloved; from their calculations a surgeon can expect to acquire HIV infection at rate of 1 in every 800 hollow needle stick injuries.…”