Despite widespread awareness about HIV that has been achieved in the past decade, apprehension regarding the dangers of surgical intervention on an HIV infected person is still prevalent. One of the most common concerns is whether hiv patients can have surgery. Let us begin by answering the above concern.
Can hiv patients have surgery?
Just like any other person, an hiv patient can have a surgery which is warranted for, having obtained informed consent and taken all necessary precautions. Many a times hiv infected patients may require urgent or elective surgeries to treat certain ailments. Both urgent and elective surgeries can be performed on hiv positive patients irrespective of their treatment history. It is a routine practice to determine the hiv status of a patient before performing any surgical intervention on the person so as to ensure adequate precautions so as to avoid risk of transmission of the disease.
Hiv can be transmitted to healthcare personnel through instruments contaminated by the infected persons body fluids if safe handling and adequate sterilisation of such instruments are not done. Sterilisation guidelines for surgical instruments are also to be strictly adhered to.
A very well known fact is that hiv affected persons have lowered levels of immunity. It is because the hiv virus targets the immune system. So it is common to have worries about post surgical recovery in patients with hiv. It is thought that hiv patients have high risk of post operative complications owing to their lowered immunity. Infections during the post operative period can delay the process of wound healing and also delay general recovery of the patient. Some awareness about the possible complications that may arise during post surgical period in hiv infected persons may be of help in making informed decision.
What are the complications of surgery in hiv infected patients?
The complications in a hiv patient during the post surgical period is mostly in the form of surgical site infection. The surgical wound may get infected due to lack of adequate local defense response elicited by the cells of the immune system. Such infections will lead to delayed healing of the surgical wound. A long standing non healing wound will lead to more severe generalised infection.
- A generalised infection stemming from the surgical site may result in septicemia. An hiv infected person may not be able to fight serious bloodstream infections effectively.
- Post surgically hiv patients are also prone for severe pneumonias due to inadequate clearance of respiratory secretions owing to position or pain.
- Surgical site infections may also give rise to abscesses. The abscesses may require further surgical drainage to be cleared .
- Intra-abdominal surgeries in hiv patients may be associated with infection of the lining of the abdominal cavity known as peritonitis.
- Hiv patients become infected with opportunistic microorganisms which usually do not infect healthy people. So the treatment for the infections should be specific so as to curtail the infecting organism.
Having read a great deal about the possible complications of surgery in an HIV infected person, it is reasonable to think if it is too dangerous for an HIV positive person to undergo a surgery. In the recent times lot of research work has been done to ascertain if the risk of surgical complications are higher among HIV patients when compared to normal people.
Is the risk of post surgical complications higher in HIV patients?
Studies have failed to prove that HIV patients are at more risk of post surgical complications when compared to the healthy people. With marked improvement in HIV treatment and control ,the rates of opportunistic infections have significantly dropped. Infections have been the major contributing factors of post surgical complications.
HIV patients who are on regular treatment and have managed to achieve good control of the disease,the white blood cell counts are enough to maintain reasonable levels of immunity.
The disease severity and prognosis is based on the viral load in the patients and their specific white blood cell counts. The HIV virus attacks the CD 4 white blood cells predominantly and kills them. The higher the viral load and lower the CD4 cell count in a patient, more severe is the disease state. Antiviral drugs used for HIV treatment reduce the viral load in the patient, thereby reducing the destruction of the patients CD4 cells.
If an HIV patients viral load and CD 4 cell counts are under check, he is less likely to develop complications owing to lowered immunity after a surgical procedure.
In the scenario of an emergency surgery on a HIV patient who has not been initiated with HIV antiviral therapy, the possibility of developing infectious complications after surgery can be minimized with the use of novel antimicrobial drugs.
Even among health care personnel which includes doctors who are well educated about the course of hiv infection and AIDS, there is huge amount of anxiety when it comes to handling HIV positive patients. It is due to the risk of accidental health care associated transmission of hiv on coming in close contact with infected body fluids.The risk doubles when it comes to invasive procedures. The operating person has high chances of coming in direct contact with the patients infected blood.
Are the doctors really at risk while operating on HIV patients ?
The reality is that if all the necessary precautions are taken, surgical procedures can be performed on HIV patients quiet safely without any risk to the surgeon. The transmission of the virus takes place only if infected body fluids from the patient comes in contact with breached skin or mucous membranes of the operating person. Another possible mode of transmission of HIV is by accidental injuries inflicted by contaminated needle sticks or sharps. Such accidental injuries can be avoided by taking adequate care. It is also important to have well trained supporting staff assisting the surgeon so as to avoid such untoward incident’s.
In case of operating on a patient who is on treatment for HIV, the patients viral load and CD 4 cell count can be used to determine the infectivity. A patient with low viral load has achieved good disease control with antiviral therapy and has very less chances of transmitting the infection even in case the surgeon has an accidental exposure.
Can a doctor refuse to operate on a HIV patient?
No, ethically and legally a doctor cannot refuse to operate on a patient citing the patients HIV positive status as the reason. If an HIV patient warrants a surgical procedure the treating doctor does not have the right to refuse him treatment on grounds that the patient is infective. The doctor can take necessary precautions to avoid transmission of the infection during the invasive procedure .
Is it legal to test every patient for HIV before surgery?
Usually every patient is tested for HIV prior to a surgical or invasive procedure so that the health care professionals can take additional precautions while performing the procedure on a HIV patient so as to avoid getting infected. This will help reduce healthcare associated transmission of HIV.
There are certain procedures that need to be followed while getting a patient tested for HIV. A patient cannot be tested for HIV without the patients consent even if it is prior to a surgical procedure. The procedures of pre testing and post testing counselling have to be strictly adhered to. An informed consent must be obtained from the patient after detailed pre test counselling. If the patient is tested positive, post test counselling should be done. Antiviral therapy against HIV should be initiated at the earliest possible situation.
Nowadays laparoscopic or minimal access surgeries have become extremely popular owing to shorter duration of hospitalisation and shorter recovery period. They are more readily accepted by the patients requiring surgery as they have smaller incisions and post operative scars. Being a novel thing people my be keen to understand if HIV patients can have laparoscopic or minimal access surgeries.
Can HIV patients have laparoscopic surgery?
Yes ,HIV patients can undergo laparoscopic surgery. As the incisions are small, there are less chances of post operative wound infection. Since the post operative recovery time is reduced,the patient will have less chances of respiratory complications.
From the surgeons perspective ,performing laparoscopic surgery on HIV patients is safer owing to limited blood spill and exposure to contaminated sharps .
The of matter concern for health care professionals while performing laparoscopy on HIV patients is the possibility of getting exposed to aerosolized HIV infected blood or peritoneal fluid while evacuating a pneumoperitoneum. Evacuating pneumoperitoneum into a closed system and adequate precautions while changing instruments will eliminate the possibility of the surgical team being exposed to aerosolized infected blood or peritoneal fluid.
In view of advanced instrument sterilisation techniques and strict guidelines regarding sterile precautions in surgery ,the transmission of infection to the general population via laparoscopic instruments is not likely.
After having answered for our readers questions such as ‘Can HIV patients have surgery?‘, yet another page on this website will bring to you details on the various precautions that need to be taken when an HIV patient undergoes a surgery .