Healthcare workers in the United Kingdom living with HIV will be permitted to carry out exposure-prone surgical and dental procedures from April 2014, the Department of Health announced today, if they are on antiretroviral treatment, receive regular medical monitoring and have an undetectable viral load.
The decision follows a public consultation in 2012 and a review of the evidence by the Expert Advisory Group on AIDS.
An exposure-prone procedure is any medical or dental procedure which carries a risk of injury to the healthcare worker that might result in bleeding into the patient’s open tissues. These might occur in surgery, dentistry and during obstetric and gynaecological procedures.
HIV testing is compulsory for all healthcare workers who carry out exposure-prone procedures, and previous regulations banned any HIV-positive healthcare worker from carrying out these procedures. This is despite extremely limited evidence of transmission from healthcare workers to patients.
The recent consultation and review of the policy concluded that the risk of transmission from healthcare workers during exposure-prone procedures was extremely low.
Based both on the lack of evidence of transmission and the accumulating evidence regarding the lack of onward transmission in people with fully suppressed viral load, the Department of Health has recommended a new procedure that will allow healthcare workers with HIV to practise while protecting patient safety.
- All healthcare workers with HIV who wish to practise exposure-prone procedures should be notified by occupational health physicians to the UK Advisory Panel for Healthcare Workers Infected with Blood-Borne Viruses (UKAP) for the first two years after revision of the guidance.
- Healthcare workers should be on antiretroviral therapy, have viral load below 50 copies/ml (undetectable) and undergo three-monthly viral load testing.
- If viral load is below 50 copies/ml, healthcare workers may continue to practise exposure-prone procedures.
- If viral load is between 50 copies/ml and 200 copies/ml re-testing should be carried out and the case should be reviewed on an individual basis if viral load is found to be between 50 copies/ml and 200 copies/ml.
- Review of safety to practise will be carried out by the patient’s treating physician and occupational health physician.
- If viral load is above 200 copies/ml, the healthcare workers should cease to practise exposure-prone procedures until viral load falls below 200 copies/ml again.
Formal guidance for the NHS on implementation is being prepared by Public Health England.
"Today’s announcement brings England into line with nations including Sweden, France, Canada and New Zealand, and is good news for patients and HIV-positive dentists alike. We look forward to seeing its implementation," said Professor Damien Walmesley, scientific advisor to the British Dental Association.