How can a surgeon become infected with HIV during an operation? Features of the work of medical staff with HIV-infected and AIDS patients. Will being HIV positive affect your options for gender reassignment surgery, plastic surgery, or gastric bypass surgery?

Surgeries for HIV help prolong the life of infected patients, as well as make the course of concomitant diseases less problematic. AIDS itself is not an indication for surgery. This disease cannot be cured surgically. This kind of intervention is necessary when the disease reaches a certain stage and causes various complications in the body. It is important to know that surgeries are performed for HIV, but there are a number of special safety measures.

Can a patient be denied surgery for HIV?

This question is the most pressing, so it should be answered first. Medical professionals do not have the right to refuse surgery to an infected patient if it does not directly threaten his life. In emergency situations, surgical operations for HIV infection are also performed. Doctors in such cases observe increased safety measures. The same applies to cases where a person with an unconfirmed immunodeficiency virus needs emergency care. Before planned procedures, an express or routine test for the presence of this disease is mandatory. If there is a direct threat to the patient’s life, then the intervention is carried out without the results of an AIDS test, but in compliance with increased safety measures.

If HIV is detected, elective surgery can be postponed, but cannot be cancelled. The postponement is due to the need for additional clinical and laboratory studies.

Surgery for HIV infection: in what cases is it indicated, planned measures

Preparation for this procedure in people with the immunodeficiency virus is carried out in a standard manner. Specialists collect anamnesis and conduct the necessary clinical and laboratory tests. This is all done taking into account the fact that this disease can be fraught with a lot of threats. We are talking about opportunistic infections and other concomitant diseases, which at certain stages are asymptomatic. Some of them may cause the surgical intervention to be postponed to a more optimal period of time. Before performing surgery on HIV-infected patients, special attention is paid to tests that reveal the quantitative composition of CD4 cells. They help determine the stage in which the immunodeficiency virus is currently located, as well as the general state of the patient’s immunity.

Is it possible to have surgery for HIV if the disease is not caused by this virus? Some pathologies and conditions of patients with immunodeficiency syndrome are not directly related to it. They can appear in patients both before and after infection. In these cases, interventions are also carried out, however, they also require increased security measures and consideration of the general condition of the infected person.

There are situations when patients have a number of contraindications that are not related to this dangerous virus. Is surgery performed on HIV-infected people in this case? There is no clear answer to this question. After all, if the intervention is planned, it may be postponed for medical reasons. We are talking about problems with the kidneys, liver, cardiovascular system or gastrointestinal tract. In emergency cases, doctors always weigh the possible threat to the patient’s life. And if it really exists, then the operation is performed even if there are contraindications.

Is HIV surgery performed on patients with intestinal obstruction? This question also often worries patients. This problem, for reasons depending on the immunodeficiency virus, occurs in approximately ten percent of patients. The rest of them are due to diseases that are in no way related to this dangerous disease. Operations in such cases are carried out because such a condition poses a direct threat to the patient’s life. After all, intestinal obstruction for a short period of time leads to general intoxication of the body.

Surgery for HIV: how does it affect the body, what are the prognoses?

People with the immunodeficiency virus at the time when they first learned to diagnose it, practically did not undergo surgical interventions. After all, the forecasts at that time were disappointing. Such patients did not live long, and the abdominal incisions festered greatly and caused a high mortality rate. In modern medicine, a lot of attention has been paid to this issue. Methods for performing surgical and laparoscopic interventions in infected people, as well as maintenance therapy regimens after such procedures, have been developed. As a result, mortality after major surgical interventions among HIV-infected people has decreased. Today it is approximately ten percent in the initial stage and thirty-three percent in the acute phase. In most cases, various types of interventions have a productive effect on the state of the body and can prolong the life of patients, as well as alleviate the symptoms of concomitant diseases.

Whether it is possible to perform surgery for HIV infection is decided by the doctor, based on the specific case.

Human immunodeficiency virus (HIV), an RNA retrovirus first described in 1981, causes severe immune deficiency. The final stage of HIV infection is acquired immunodeficiency syndrome (). About 1.5 million US citizens are infected with the human immunodeficiency virus. Of these, more than 200,000 have AIDS. Every year the number of cases increases 1.2 times. A significant increase in the number of infected and sick people in Russia is expected by 1998.
A. HIV infection. The disease is chronic. HIV infects cells that have the CD4 marker on their surface (for example, T-helper cells), which binds to the HIV envelope glycoprotein. All parts of the immune system suffer, especially the cellular one. Opportunistic diseases and tumor processes develop. The range of manifestations of the disease depends on the degree of immunosuppression.
1. The spectrum and frequency of opportunistic infections and tumors depends on the degree of immunosuppression and the number of surviving T-lymphocytes with the CD4 marker (Table 3-1).

Table 3–1. Relationship between CD4+ T-lymphocyte counts and secondary pathology in HIV infection

* If the CD4 + T-lymphocyte count is less than 500, antiretroviral therapy (zidovudine) is indicated

# CD4+ T cell count<200 указывает на необходимость профилактики пневмоцистной пневмонии (бисептол, пентамидин).

2. Most secondary infections are treated conservatively. Their complications may require surgery. Surgical diseases (for example, small bowel obstruction in the visceral form of Kaposi's sarcoma) occur in less than 5% of AIDS patients.
3. Life expectancy after HIV infection is 8–10 years. Traditional antiretroviral therapy and prevention of Pneumocystis carinii pneumonia prolongs life by another 1–2 years.
A. Initial surgical results in AIDS patients were disappointing. Postoperative mortality was high, and there was no increase in long-term survival at all.
b. Recent studies suggest that morbidity and mortality after major surgery in patients infected with HIV are significantly less than previously thought. This primarily applies to patients with an asymptomatic stage of HIV infection and patients undergoing surgery for diseases not related to AIDS.
V. One should not refrain from operations that can save the patient’s life or improve its quality, or reduce the severity of the disease.
4. HIV-infected surgical patients are treated according to standard regimens.
B. Survey
1. History
A. When collecting anamnesis, risk factors for HIV infection are identified (sexual orientation, intravenous injections, blood transfusions, surgical interventions, organ transplantation, etc.).
b. Particular attention should be paid to prolonged low-grade fever, generalized lymphadenopathy (enlargement of 3 or more lymph nodes in 3 or more groups), hepatosplenomegaly, unexplained weakness - symptoms of the initial manifestations of HIV infection.
V. Previous opportunistic infections should be noted, as well as previous results of counting the number of T-lymphocytes and the content of serum immunoglobulins.
d. Antiretroviral therapy administered and the results of prevention of opportunistic infections should also be documented.
2. Objective research. In the stage of initial manifestations (stage II of HIV infection), the patient may have a mononucleosis-like syndrome, including pharyngitis, fever, lymphadenopathy, hepatosplenomegaly, sweating; It should be remembered that during this period patients are seronegative. In the stage of secondary diseases (stage III of HIV infection), signs of immunosuppression appear, opportunistic diseases arise: common candidiasis of the skin and mucous membranes, Pneumocystis pneumonia, hairy leukoplakia, Koloshi sarcoma; generalized infections caused by conditionally pathogenic flora. It is important to remember that a patient with immunosuppression may not have obvious symptoms of the disease.
3. Laboratory research. If there is only a suspicion of HIV infection, the diagnosis is confirmed using enzyme-linked immunosorbent assay and blotting. When HIV infection is diagnosed, Ht, the number of leukocytes, platelets, CD4+ T-lymphocytes, CD8+ T-lymphocytes, the CD4+/CD8+ T-lymphocyte ratio are determined (normally this indicator is about 1.0); perform a general urine test. Biochemical tests include determination of albumin, serum immunoglobulins and liver function tests. A chest x-ray is performed. If there are signs of an opportunistic infection, bacteriological, serological and virological studies should be carried out.
4. Radiation diagnostics. Patients with abdominal pain of unknown origin undergo an abdominal CT scan.
IN. Risk assessment
1. AIDS patients are susceptible to complications to a much greater extent than HIV-infected individuals (who do not have symptoms).
A. Mortality after major abdominal surgery in patients with AIDS is 33%, and in HIV-infected patients - 10%.
b. No laboratory indicator, taken separately from others (including the number of CD4+ T-lymphocytes), can predict the outcome of the operation. Presumable factors for a high risk of postoperative complications:
(1) opportunistic infection,
(2) insufficient prevention of AIDS-associated diseases,
(3) hypoalbuminemia due to opportunistic infection.
2. Emergency operations are accompanied by a greater risk than planned interventions.
A. Mortality after emergencies in patients with AIDS ranges from 11 to 24%.
b. Surgical diseases caused by AIDS increase the risk during emergency operations by 3–4 times. Approximately 37% of patients require repeat surgery.
3. A poor prognosis is typical for the visceral form of Kaposi's sarcoma, undifferentiated lymphoma and Mycobacterium avium-intracellulare infection.
G. Prevention of infection. When performing an operation on an AIDS patient, you should strictly adhere to the established rules.
1. Since before the operation it may not be known that the patient is HIV-infected, the Centers for AIDS Control (USA) recommends taking into account the possibility of infection in any patient and operating on him with appropriate precautions (so-called universal precautions).
2. Blood is the most common source of infection with HIV and hepatitis viruses transmitted parenterally in the area of ​​influence. Other fluids that can transmit HIV include CSF, synovial fluid, pleural fluid, pericardial fluid and amniotic fluid, as well as semen and vaginal secretions.
3. Infection during professional activities can occur through contact with blood, biological fluid contaminated with it, or a virus culture. Possible percutaneous inoculation, infection of an open wound or damaged skin or mucous membrane. The risk of transmission by needlestick is less than 0.03%. In terms of HIV infection, blood is the most dangerous.
4. If there is a possibility of contact with blood and body fluids, you must wear protective clothing before the procedure: gloves, goggles, mask and gown. The kit must be disposable and liquid-tight.
5. Work skills should be developed to reduce the risk of infection.
A. Handle sharp instruments with care.
b. Ensure good lighting and careful organization of the surgical field to reduce the likelihood of accidental infection.
V. Move tissue apart with tools, not with hands.
d. Restrict access to the operating room to “unnecessary” personnel.
d. Do not trust operations involving the risk of HIV infection to inexperienced surgeons.
D. Gastrointestinal pathology that does not require surgery
1. Diarrhea is a common symptom of AIDS. Taking on a debilitating nature, it can lead to exhaustion and dehydration.
A. The most common causes of diarrhea are Clostridium difficile, Cryptosporidium, Isospora belli, Entamoeba histolytica, Giardia and viruses.
b. Somatostatin may reduce the severity of diarrhea in AIDS.
2. Intestinal bleeding is often caused by infectious colitis. The likelihood of bleeding from a malignant tumor is low. In addition to typical pathogens of intestinal infections, the disease can be caused by herpes simplex virus (HSV), cytomegalovirus (CMV) and Entamoeba histolytica.
3. Pancreatitis can be caused by a viral infection or the use of pentamidine or 2?,3?-dideoxyinosine.
E. Diagnostic interventions
1. Lymph node biopsy. Approximately 20% of patients infected with HIV develop generalized lymphadenopathy. In this group, the risk of developing AIDS-associated lymphoma is very high.
A. Fine needle aspiration is used to obtain fluid for microbiological, serological and cytological studies.
b. An open biopsy may be required to exclude a tumor or to study the histological architecture of the lymphoma. A biopsy should not be performed unless the result changes the treatment plan.
2. Open or thoracoscopic lung biopsy is necessary to diagnose a pulmonary process if less invasive diagnostic interventions (eg, bronchoscopy, bronchoalveolar lavage, transbronchial biopsy, transthoracic aspiration biopsy) have been unsuccessful.
AND. Other surgical diseases. Standard indications for surgery (for example, perforation, intestinal obstruction, bleeding refractory to drug therapy, undoubted signs of progressive peritonitis) also apply to HIV-infected people.
1. Acute - a disease that occurs in patients with HIV infection with normal frequency. Despite the huge number of infectious diseases involved in the differential diagnosis, the possibility should be considered in patients with immunodeficiency. In difficult situations, the diagnosis can be clarified using laparoscopy. Mortality and complication rates during appendectomy in HIV-infected patients are common.
2. Diseases of the biliary tract
A. Acute cholecystitis may be secondary - due to infection caused by Cryptosporidium or CMV, which is practically not excreted; Therefore, drug therapy for cytomegalovirus cholecystitis is not effective; there is no etiotropic therapy yet.
(1) Radiation diagnostics. Significant thickening of the gallbladder walls and edema are detected.
(2) Cholecystectomy. Mortality and incidence of complications during cholecystectomy in HIV-infected patients are the same as in other patients.
(3) During cholecystectomy, intraoperative cholangiography is necessary to exclude bile duct obstruction and stenosis of the major duodenal papilla.
b. Lesions of the biliary tract in AIDS. In persons infected with HIV-1, the spectrum of biliary tract dysfunction is wide: cholestasis, ampullary stenosis, etc. are possible. To restore the patency of the ducts, endoscopic retrograde in combination with papillosphincterotomy and the introduction of frames may be required.
3. is indicated if the patient has thrombocytopenia (including those associated with immunodeficiency), and drug therapy does not have an effect. The incidence of complications and mortality after surgery is moderate.
4. Diseases of the anus and rectum occur more often in homosexuals infected with HIV. Palliative operations are often performed to alleviate the course of the disease.
A. Genital warts in people affected by HIV can grow rapidly, involving large areas of the mucous membrane and reaching large sizes. Neoplastic transformation often occurs.
b. Rectal fistulas are sanitized only when tissue is necrotic.
V. Chronic anal ulcers. To exclude malignancy, a biopsy is indicated. Microbiological testing should be performed to detect HSV, CMV, Treponema, Chlamydia trachomatis, Haemophilus ducreyi and acid-fast bacteria.
5. Colitis caused by CMV. CMV infection leads to vasculitis, ischemia and necrosis of the intestinal wall. In case of perforation, surgical intervention is necessary. It is not always possible to accurately determine the area of ​​the lesion. Therefore, it is recommended to complete the resection of clearly changed areas with the formation of an end colostomy or ileostomy.
6. Non-Hodgkin's lymphoma and Kaposi's sarcoma affect the gastrointestinal tract in the terminal stage of AIDS. Possible symptoms: inflammatory infiltrates or bleeding. The lesions are usually multicentric and disseminated. Conservative treatment is preferable. The operation is performed only if there is no alternative.
H. Postoperative complications. The incidence of complications in patients suffering from HIV infection is no higher than usual. Infectious complications vary depending on the severity of the immunodeficiency.
1. Postoperative pneumonia occurs frequently, especially in patients who were on mechanical ventilation. In patients with low CD4+ T-lymphocyte counts, Pneumocystis pneumonia should be suspected.
2. Many patients experience prolonged postoperative fever for no apparent reason.

Few people on this site know that I used to work in a laboratory diagnosing HIV infection, hepatitis and syphilis. Even earlier, when I was studying, I would never have thought that I could go to work there. I didn’t want to risk my life without “tasting it” yet. Although I understand that the routes of infection can be different and it is not necessary to label a person as a drug addict or a prostitute.

There was an incident in my life. I just graduated. I went to work. At first I received her at the clinic under the watchful eye of my mentors. Then I was quickly assigned to the hospital. Well, one fine day I have a bunch of forms for the intensive care and gynecology department. Resuscitation always comes first for me, because... It's always hard there. Not only to work, but also to be. People are not always in recovery. It’s easier in gynecology. Mostly young, sociable. Positive. ... There is only one girl left. Everything in the suitcase is already prepared for blood sampling, the cotton wool is also ready. I take the scarifier, prick it, am about to throw it off and... it sticks to the glove and pierces my finger. The feeling of anxiety did not leave me, but I completed the work. Of course, I treated the wound and squeezed out the blood at the puncture site. But there was panic in my soul. I've never run so fast before. Rather, for the device and the results of the girl’s blood are already in my hands. She turned out to be even healthier than me. Cosmonaut:) Laugh, laugh, but this is what I'm leading to: p Lately in our country there are more and more people living with terrible diagnoses - HIV-infected and AIDS.Not just doomed, but living. They, like all healthy people, live their lives to the fullest: they work, travel, get married, give birth and raise children. We must understand that an HIV-infected person and an AIDS patient are different stages of the disease. Their main difference is that the stage of AIDS is more severe than the stage of HIV infection, so often the infected person feels completely healthy. It has been proven that from the stage of HIV infection to the development of AIDS, it can take from five to fifteen years.How do plastic surgeons treat people with HIV infection and the AIDS stage? Could you, if you were in the place of a surgeon, not disdain operate on such a patient? Controversial question...