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A 13-Year Look-Back Study

C. Fordham von Reyn, MD; Thomas T. Gilbert, MD, MPH; Frederic E. Shaw, Jr, MD, JD; Kathy C. Parsonnet, MEd, MPH; Jean E. Abramson, MSW, MAS; M. Geoffrey Smith, MD, MPH

JAMA. 1993;269(14):1807-1811.

Abstract
Objective.
—To determine the risk of human immunodeficiency virus (HIV) transmission from an HIV-infected orthopedic surgeon to patients undergoing invasive procedures.

Design.
—Retrospective epidemiologic follow-up study.

Participants.
—A total of 2317 former patients on whom the orthopedic surgeon performed invasive procedures between January 1, 1978, and June 30, 1992.

Main Outcome Measures.
—HIV infection or death from an acquired immunodeficiency syndrome (AIDS)—defining tumor or opportunistic infection.

Results.
—An orthopedic surgeon voluntarily withdrew from practice after testing positive for HIV. Testing for HIV was performed on 1174 former patients, representing 50.7% of patients on whom the orthopedic surgeon performed invasive procedures during the 13.5-year period. Patients were tested from each year and from each category of invasive procedure. All patients were HIV-negative by enzyme-linked immunosorbent assay. Two former patients reported known HIV infection prior to surgery. Review of AIDS case registries and vital records failed to detect cases of HIV infection among former surgical patients. The estimated cost of the initial patient notification and testing was $158500. The patient notification and testing were conducted while maintaining the confidentiality of the orthopedic surgeon who was an active participant in the planning and execution of the study.

Conclusions.
—The risk of HIV transmission from an HIV-infected surgeon who adheres to recommended infection control practices is extremely low. Notification and HIV testing of former patients in this setting is both disruptive and expensive and is not routinely recommended.

(JAMA. 1993;269:1807-1811)

Author Affiliations
From the Infectious Disease Section, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (Dr von Reyn, and Mss Parsonnet and Abramson); the Department of Family Medicine, Brown University School of Medicine, Providence, RI (Dr Gilbert); and the Division of Public Health Services, New Hampshire Department of Health and Human Services, Concord (Drs Shaw and Smith).

Footnotes
Presented in part at the Eighth International Conference on AIDS, Amsterdam, the Netherlands, July 20, 1992.

Reprint requests to the Infectious Disease Section, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756 (Dr von Reyn).

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