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HIV/AIDS AND TRAUMA
TAOLE MOKOENA MBChB
(Natal) DPhil (Oxon) FRCS
TRANSMISSION OF HIV
Major routes:
• Sexual contact with infected person
• Perinatal transmission from mother to child
• Infusion or inoculation of infected blood eg
BTF or shared needles especially drug addicts
• Inoculation of blood through skin penetration by
sharp instruments is major route in health care
workers!
PROGRESSION OF HIV TO AIDS
• Mean incubation period of HIV infection until
AIDS symptoms is 8 – 11 years (without
treatment)
• Great variation in rate of progression to AIDS
• Full Blown AIDS survival:
- 1 year survival 49%
- 5 year survival 15%
- Mean survival with CD4 count < 200 = 3,7
years
TRANSMISSION OF HIV FROM PATIENT
TO STAFF
• Principally through contaminated hollow needle injuries
• Mixing of blood during intra-operative injuries
• Solid needles and intact mucus membrane transfer a
distinct possibility but very low < 0.09%. No hard data to
support it
• No documented seroconversion from solid needle or
aerosolisation in OT
• Testing patients for possible transfer not infallable
because of window period
• Seroconversion depends of viral load of inoculum
• Current risk estimated at 0.3% after percutaneous hollow
needle injury
TRANSMISSION OF HIV FROM
STAFF TO PATIENT
• Early report of transmission from staff
(dentist) to patient
• Since HIV/AIDS awareness no further
documentation of such transmission
PRECAUTIONS AND PROPHYLAXIS AGAINST
OCCUPATIONAL HIV TRANSMISSION
• Universal precautions
- gloving always
- double glove during surgery
- waterproof apron
- protective eye/face device
• Extra precaution during procedures on known
HIV patients
• Post exposure prophylaxis
- reduces risk of transmission by 80%
OUTCOME OF SURGERY IN
HIV/AIDS PATIENTS
• Generally morbidity and mortality in HIV infected patient comparable
to uninfected for most surgical procedures
1) Nose Nose D V et al. AIDS 1998; 12 : 2243 – 2251
2) Ayers J et al. Chest 1993; 103 : 1800 - 1807
3) Franz J et al. Infect Dis Obstet & Gynecol 2005; 13 : 167 – 169
• Certain categories of surgery show higher morbidity
eg 1)
Abdominal aortic surgery - Lin P H et al. Am J
Surg 2004; 188 ; 690 – 697
eg 2)
Obsteterics surgery (C/s) – Ferrero S &
Bentivoglio. Arch Gynecol Obstet 2003; 268 :
268 - 273
eg 3)
Gynaecological surgery – Grubert T A et al. Clin Infect
Dis 2002; 34 : 822 – 830
• Therefore no patient must be denied deserved surgery
DETERMINANTS OF POST-OP
OUTCOME IN HIV PATIENTS
• Immune status
- full blown AIDS
- low CD4 count
• Poor nutrition
• Main morbidity are post-op infections and
wound breakdown
• Antiretroviral treatment reverses high risk
tendency
OUTCOME IN HIV PATIENTS
AFTER TRAUMA
• No specific studies
• Emergency surgery in HIV patients generally
shows similar outcomes to HIV naive patients
• Therefore no trauma patient must be denied
surgical intervention on account of HIV
• Surgeon must however be more vigilent for postop complications and apply prophylaxis
generously