INFECTION CONTROL17 Aids

HIV INFECTION

The acquired immune deficiency syndrome (AIDS) was first described in 1981 and the human immunodeficiency virus (HIV) was first identified in 1983.

•     In 1983 the receptor cell for the virus was identified as the CD-4 of T-helper cell

•     Antibody tests were developed which revealed the HIV status of the individual

•     In 1986 a second strain, HIV 2, was isolated

•     Like hepatitis B, the virus is present in blood and body fluids, but unlike hepatitis B is relatively easily destroyed outside the body, and is not as infectious as the hepatitis B virus

•     Infection of the surgeon can occur from contamination from infected blood or body fluids, either through an open wound, or from a puncture wound like a needle-stick injury

•     Following infection there is an asymptomatic period during which antibody to the virus is not yet present in the blood, and thus HIV tests will be negative

•     After approximately 6 months the infected individual may seroconvert, and the HIV antibody be detected

•     A high proportion will then progress to develop AIDS

•     A common presenting feature of AIDS sufferers is the Kaposi sarcoma, with an incidence of between 25 and  50 percent. Biopsy of such lesions may be the first contact the surgeon has with this disease

•     Kaposi sarcomas present as pink to purple blotches like a bruise or blood blister. They may be flat or raised. They are skin cancer arising from the endothelial cells such as those lining blood vessels. Histologically, malignant transformation causes the endothelial cells to become stippled with spindle-shaped tumor cells; lymphatic obstruction may occur, but they do not metastasize, and remain multifocal both on the skin and in the alimentary tract. Despite the worry of surgeons about risks of infection, these risks are small

•           The prevalance rate of HIV 0.3 to 7 percent in our country. Surgeons have been shown to contaminate themselves with blood in 8.7 percent cases, and sustain penetrating injuries in 1.7 percent cases the transmission rate is 0.3 to 0.4 percent, yet statistically the risk of seroconversion for a surgeon is one infection every 8 years in a high-risk area with a case-load of 15000 patients per year, and as small as one infection every 80 years in a low risk area. Thus the risk to surgeon is exceptionally low.

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