Surgeons Being Voluntarily Tested for AIDS Virus

The federal government and the American Academy of Orthopaedic Surgeons have begun the nation’s first large-scale voluntary testing program to determine the percentage of surgeons who are infected with the human immunodeficiency virus, the cause of AIDS.

More than 100 technicians and counselors hired by the U.S. Centers for Disease Control are expected to test about 3,000 orthopedists this week and next at the academy’s annual meeting in Anaheim.

The testing, conducted in a large tent outside the meeting, will be used “both for research to help determine the incidence of AIDS in one (high-risk) medical speciality . . . and as a service to individuals to let those who are infected know of their condition,” said Dr. Mary E. Chamberland, the CDC official who is overseeing the testing.

The study is the latest development in the contentious debate over the risks that HIV-infected physicians pose to their patients and the related issue of the rights of physicians, particularly surgeons, to require their patients to be tested for the virus. Many physicians, especially those who work in inner-city hospitals or treat accident victims, are concerned about the risks of contracting the AIDS virus from their patients.

Most medical groups oppose mandatory testing of physicians for HIV infection. But medical experts disagree about whether doctors who know that they are infected have an obligation to either notify their patients or to stop performing surgery or other invasive procedures. The concern is that infected surgeons who cut themselves during an operation might bleed into their patients, thereby transmitting the virus.

The Centers for Disease Control, responding to a Florida case in which a dentist with AIDS apparently infected at least three of his patients, is in the process of formulating national guidelines for HIV-infected health care workers.

In advance of the orthopedic meeting, all 15,600 members of the academy were sent a letter, urging them to participate in the study. So far, participation has been brisk.

CDC officials point out that the surgeons who volunteer to be tested may not be representative of the orthopedic profession as a whole. Therefore, they are collecting detailed information about the age of the participants, where they live, their medical practices and their AIDS “risk” factors, such as homosexual intercourse or the receipt of blood transfusions.

With this information, CDC researchers hope to reach tentative conclusions about the prevalence of AIDS among all orthopedic surgeons and perhaps among other groups of surgeons as well. Orthopedists, along with trauma surgeons and obstetricians have a particularly high risk of exposure to blood while they work.

“There is so much we simply do not know about AIDS,” Chamberland said. “We hope this (survey) will tell us a little more. The is one piece of a puzzle we’re trying to put together.’

Earlier this week, the board of the orthopedic academy issued guidelines calling on its members to be voluntarily tested for AIDS on a periodic basis and to “promote the voluntary testing of their patients.”

In addition, the board said that surgeons who are infected with the AIDS virus “should not perform invasive surgical procedures,” except in emergencies or when the patient or his or her family has been fully informed of the physician’s infection.

A surgeon “does not have an obligation to respond to patient inquiries regarding his or her status unless invasive procedures are to be performed,” the board said. However, “the academy believes that, within the confines of the law, orthopedic surgeons should have access to the HIV status of their patients.”

Most surgeons interviewed at the meeting said they intend to participate in the HIV testing. As one surgeon from Des Moines put it: “It is better to know than not to know, but most of us are not in practices where the risks (of being infected by a patient) are high.”

While overall data will not be available for several months, individual physicians can learn the results of their own blood tests within 24 to 48 hours. This will be done through an anonymous coding system designed to protect their confidentiality.

The risk of HIV transmission to a patient during a surgical or dental procedure is believed to be small. Precise figures, however, are not available.

The CDC recently estimated that from 1981 to 1990, between 13 and 128 Americans had been infected by either their dentists or surgeons. There are no comparable estimates of how many dentists or surgeons have been infected by their patients.

A number of studies have examined the risk of acquiring HIV infection from a single exposure to an infected person’s blood. They have found that an HIV infection will occur in one of every 250 people who are accidentally pricked with a contaminated needle. The risk from a scalpel injury is thought to be greater because more bleeding may occur.

An annual series of health tests conducted by the American Dental Assn. has also attempted to determine the number of HIV-infected health care workers, according to federal health officials. But only about 1,500 to 1,600 of the nation’s more than 160,000 dentists voluntarily participate in that program, which also includes testing for other health problems.

The dental survey is used solely for research purposes within the association and the results are not made public.