When the Doctor Has AIDS

NOTE FROM DR. MERLE A. SANDE-Twice we have addressed the risk for health care workers of acquiring human immunodeficiency virus (HIV) infection from AIDS patients and have debated justifications for proposed HIV testing ofpatients. Here the responsibility ofan HIV-infected health care worker is examined. Does an HIV-infected health care worker ever pose a risk to patients? Is there a reasonable risk that the virus will accidentally be transmitted? Though we know of no case of HIV transmission during invasive procedures or patient care duties, such would be difficult to identify. What constitutes reasonable risk? Could the degree be stratified by estimating the probability of exposure and transmission (e.g., during a vaginal hysterectomy vs. during a pelvic examination)? Should the clinical stage of HIV infection be considered? Viral titers in plasma usually increase as HIV infection progresses. Would antiviral therapy lessen the risk of transmission by reducing titers? Is risk stratification possible given our limited understanding of HIV infectivity? Should health care workers be tested for mv? Does the patient's right to know outweigh the physician's right to confidentiality? Does the risk of transmission warrant restricting infected clinicians from certain procedures, or should high standards of infection control be emphasized and compliance monitored? If our profession does not effectively grapple with such questions, they will be answered for us in the courts.