Probable Transmission of HIV from an Orthopedic Surgeon to a Patient in France

5 January 1999 | Volume 130 Issue 1 | Pages 1-6

Background: Transmission of HIV from infected health care workers to patients has been documented in only one cluster involving 6 patients of a dentist in Florida. In October 1995, the French Ministry of Health offered HIV testing to patients who had been operated on by an orthopedic surgeon in whom AIDS was recently diagnosed.

Objective: To determine whether the surgeon transmitted HIV to patients during operations.

Design: Epidemiologic investigation.

Setting: The practice of an orthopedic surgeon in a French public hospital.

Participants: 1 surgeon and 983 of his former patients.

Measurements: 3004 patients who had undergone invasive procedures were contacted by mail for counseling and HIV testing. One HIV-positive patient was interviewed, and DNA sequence analysis was performed to compare the genetic relation of the patient's and the surgeon's viruses. Infection-control precautions and the surgeon's practices were assessed.

Results: Of 983 patients in whom serologic status was ascertained, 982 were HIV negative and 1 was HIV positive. The HIV-positive patient, a woman born in 1925, tested negative for HIV before placement of a total hip prosthesis with bone graft (a prolonged operation) performed by the surgeon in 1992. She had no identified risk for HIV exposure. Molecular analysis indicated that the viral sequences obtained from the surgeon and the HIV-infected woman were closely related. Infection-control precautions were in accordance with recommendations, but blood contact between the surgeon and his patients occurred commonly during surgical procedures.

Conclusions: An HIV-infected surgeon may have transmitted HIV to one of his patients during surgery.

Author and Article Information

Requests for Reprints: Florence Lot, MD, Réseau National de Santé Publique, 14 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France; e-mail, Lot@b3e.jussieu.fr.

Current Author Addresses: Drs. Lot, Desenclos, and Drucker: Réseau National de Santé Publique, 14 rue du Val d'Osne, 94415 Saint-Maurice Cedex, France.

Drs. Séguier, Fégueux, Simon, van Amerongen, and Cheron: Hôpital de Saint-Germain-en-Laye, 20 rue Armagis, 78105 Saint-Germain-en-Laye, France.

Drs. Astagneau and Brücker and Ms. Aggoune: Centre Inter-régional de Coordination pour la Lutte contre les Infections Nosocomiales Paris-Nord, Institut Biomédical des Cordeliers, 15 rue de l'Ecole de Médecine, 75006 Paris, France.

Dr. Ruch: Direction Départementale des Affaires Sanitaires et Sociales des Yvelines, 11 rue des Réservoirs, 78007 Versailles Cedex, France.

From Réseau National de Santé Publique, Saint-Maurice, France; Centre Interrégional de Coordination pour la Lutte contre les Infections Nosocomiales Paris-Nord, Paris, France; Hôpital de Saint-Germain-en-Laye, Saint-Germain-en-Laye, France; and Direction Départementale des Affaires Sanitaires et Sociales des Yvelines, Versailles, France.

Acknowledgments: The authors thank Didier Armengaud, MD, Martine Engerrand, MD, Catherine Freydt, MD, Abdon Goudjo, MD, Karim Hamidi, MD, Michel Janowski, MD, Zoë Le Lostec, MD, Emmanuel Meeus, MD, Charlotte Sansom, MD, Yves Welker, MD, and the Réseau Ville-Hôpital AVH-78 for their participation in counseling; Armelle Boisivon, MD, for coordination of serologic tests; Jean-François Bouziat for computer assistance; Kathia Bernard, Nadou Foucard, and Sonia Prunier for secretarial assistance; Agnès Bernoux for help during the investigation; Robert Cappe, Christian Ferro, and the administrative personnel of Hôpital de Saint-Germain-en-Laye for their assistance; Alain Blanchard, ScD, Stéphane Ferris, MSc, Sophie Chamaret, MSc, Denise Guétard, MSc, and Luc Montagnier, ScD, MD, of the Institut Pasteur, for viral study; David Bell, MD, and Adelisa Panlilio, MD, MPH, of the Centers for Disease Control and Prevention, for expert advice and review of the manuscript; and the orthopedic surgeon described in this report for his cooperation and substantial contributions.