Consultation is launched on relaxing rules for HIV positive doctors
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7949 (Published 06 December 2011) Cite this as: BMJ 2011;343:d7949The government has launched a consultation on relaxing the restrictions that apply to HIV positive healthcare workers in the United Kingdom after a review of the current evidence.
At present healthcare workers with a diagnosis of HIV are not allowed to perform “exposure prone procedures” that carry a risk that the worker could injure themselves and bleed into the patient’s mucous membranes, wound, or traumatised tissue. Such clinical procedures occur mainly in surgery, obstetrics and gynaecology, midwifery, dentistry, and some aspects of specialist nursing.
A working group comprising the Expert Advisory Group on AIDS, the UK Advisory Panel of Healthcare Workers Infected with Blood-borne Viruses, and the Advisory Group on Hepatitis has recommended that HIV positive healthcare workers be permitted to perform exposure prone procedures if they are taking combination antiretroviral treatment and have a very low or undetectable plasma viral load.
Healthcare workers infected with HIV who wish to perform exposure prone procedures should demonstrate a sustained response to combination antiretrovirals and be subject to viral load testing every three months, they add.
The risk of HIV transmission from a healthcare worker whose infection is undiagnosed and who remains untreated is extremely low for the most invasive procedures, such as open heart surgery, and negligible for the least invasive procedures, such as injections, the tripartite working group has said. The current overall risk of HIV transmission to any patient having the most invasive type of exposure prone procedure from any healthcare worker, regardless of HIV status, is estimated to be between one in 1.7 million and one in 4.7 million.
Only four incidents of transmission of HIV from a healthcare worker to a patient have been reported worldwide, and no cases have been reported in the UK. However, more than 30 patient notification exercises took place between 1988 and 2008 in which nearly 10 000 patients were tested for HIV.
“Our careful review of the evidence suggests that the current restrictions on healthcare workers with HIV are now out of step with evidence about the minimal risk of transmission of infection to patients and policies in most other countries,” said Brian Gazzard, chairman of the Expert Advisory Group on AIDS. “This risk can be reduced even further if the healthcare worker is taking effective drug therapy for HIV and being monitored by HIV and occupational health specialists.”
The British HIV Association has welcomed the proposals to modify the working restrictions. “The position of HIV positive healthcare workers has been very difficult, and highly qualified professionals are not able to use their skills to their full potential,” said Jane Anderson, the association’s chairwoman. “Changing this regulation would be a very welcome step that will help reduce the stigma and discrimination that is associated with HIV infection.”
The consultation document is available on the Department of Health’s website at www.dh.gov.uk/en/Consultations/Liveconsultations/DH_131532.