Obstetrician infects patient with HIV during caesarean delivery

A Spanish woman has been infected with HIV by her obstetrician during a caesarean section. The case is reported in the January 9^th edition of AIDS. It is thought that the infection occurred as a result of a needle stick injury which the doctor, who did not know he was infected with HIV at the time, experienced during the procedure. Genetic anaylsis of the obstetrician’s and the patient’s HIV indicated that the doctor was the likely source of the infection.

There have been very few reports of healthcare workers infecting their patients with HIV. It is thought that a dentist in Florida infected five patients; that an orthopaedic surgeon infected one of his patients; and that a nurse infected a patient. Genetic testing of HIV from the healthcare workers and the patients was used in these instances to confirm that the healthcare practitioner was the source of the infection.

Doctors from Madrid report the case of a 32-year-old woman who had a caesarean delivery. She had a negative HIV antibody test and HIV viral load test as part of her routine pregnancy care and was in good health. There were no complications during the caesarean section that delivered a healthy baby girl. However, two weeks later she developed a high temperature, swollen glands and a generalised rash. Blood samples obtained ten weeks after the caesarean section indicated that the woman was infected with HIV. At this time her CD4 cell count was 607 cells/mm³ and her viral load 1,400 copies/ml. The woman’s baby and partner tested HIV-negative.

The obstetrician who performed the caesarean was a healthy gay man. He did not know his HIV infection status at the time he performed the procedure, but admitted that he had suffered a needle stick injury during the operation. A blood sample obtained seven months after the caesarean tested HIV-positive. The doctor has a CD4 cell count of 720 cells/mm³ and a viral load of 1,500 copies/ml.

Genetic tests were performed on samples of HIV obtained from the doctor and the woman, indicating that they were both infected with genetically very similar HIV. As the woman’s partner and baby were HIV-negative, the investigators concluded that the obstetrician was the likely source of his patient’s infection.

“This report illustrates that HIV can be transmitted from an infected healthcare worker to a patient during invasive procedures”, write the investigators.