AIDS and the anaesthetist

  • C.A. H
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Abstract

Manifestation of AIDS follows a loss of T4 helper cells. This results in impaired humoral and cell-mediated immunity, and allows the development of opportunistic infections and tumours. Human immunodeficiency virus (type 1 or 2) is responsible for this suppression of immune function. The virus principally infects cells bearing the T4 receptor, although other cell types are infectable. HIV is a slow retrovirus. Following infection, viral RNA is back-transcribed to proviral DNA; this means that once infected with HIV an individual is infected for life. Patients are often asymptomatically infected with HIV for years prior to the development of AIDS. Although most HIV-infected individuals produce antibody, some do not. There is as yet no evidence of nosocomial spread of HIV from patient to patient. However, it must be remembered that patients with AIDS will be infected with pathogens of varying virulence which can be transferred nosocomially. They are also immunoincompetent and may be at risk of nosocomial acquisition of pathogens from other patients. The risk of acquisition of HIV by health-care personnel from infected patients is low. Thus far, only 21 such cases have been documented in developed countries. This risk of transfer is linked to types of procedure rather than to particular risk occupations in hospitals. Those who undertake procedures in which it is possible that HIV-infected blood or other body fluids such as cerebrospinal fluid might be directly inoculated into the circulation via needle-stick or other 'sharps' injury are at greatest risk. The majority of cases of transfer of HIV to hospital staff have involved this route. In prospective surveys the risk of HIV infection via needle-stick injury is less than 0.5% (compared with 5-25% for hepatitis B virus infection) . The risk of transfer by skin or mucous membrane contact with HlV-infected blood is even lower (less than 0.2%), but two such cases have been recorded. There is no evidence that casual contact will spread HIV infection. Procedures have been devised to decrease the risk of HIV infection of health-care personnel.

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APA

C.A., H. (1991). AIDS and the anaesthetist. Bailliere’s Clinical Anaesthesiology, 5(1), 243–260. Retrieved from http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed2&NEWS=N&AN=1991309914

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