CDC Considers ‘Loosening’ Rules Restricting HIV-Positive Doctors from Performing Invasive Procedures Without Patient Consent

The CDC is considering " loosening" its guidelines that recommend barring HIV-positive doctors from performing certain "invasive procedures" without patient consent and approval from a panel that includes a state or local health official, the AP/San Jose Mercury News reports. Since the government issued the guidelines in 1991, only six incidents of transmission from provider to patient have been documented in the United States, and these cases all stem from a single Florida dentist. In addition, the AP/Mercury News reports, "no one can say just how" the dentist infected his patients. In 1987, the CDC issued "universal infection control precautions" aimed at shielding health workers from contracting HIV from patients. These guidelines, which recommend that providers wear gloves, masks and goggles "whenever contact with bodily fluid is anticipated," also help prevent HIV transmission from provider to patient. A 1998 report by the American Medical Association's Council on Scientific Affairs found that further advancements in medical techniques have "reduced the risks of transmission even in invasive procedures." The report recommended that the CDC "consider amending its guidelines" so that the restrictions apply only to infected health care workers who pose "a significant risk" to patients (Tanner, AP/San Jose Mercury News, 4/1). Last month, a member of the Presidential Advisory Council on HIV and AIDS also recommended that the guidelines be loosened to instead focus on implementing "standard (universal) precautions," such as barrier protections, to "manag[e] ... the workplace environment and injury prevention" ( Kaiser Daily HIV/AIDS Report, 2/23).

Relaxing the Regulations
While some health experts point to the small number of provider-to-patient transmission cases as indicative of "how tiny the risks are," others say that the transmission rate has remained low precisely because of the guidelines and the "success of increased infection control practices" prompted by the cases. Dr. Kenneth Mayer, director of a Brown University AIDS program, said that doctors today are also better informed about HIV transmission and prevention. "The presumption is now that if you're a health care worker you're sophisticated enough to know that the medications we have now can make you less infectious," he said. Dr. Robert Wood, an HIV-positive physician who is urging the CDC to relax the recommendations, is "dismayed" by the guidelines, stating that they represent "knee-jerk responses that sort of were below the level of scientific scrutiny." But Dr. John Nelson, a Salt Lake City obstetrician and an AMA trustee, said that the fact that there have only been six documented cases of provider-to-patient transmission "suggests that stringent precautions and practices are working." The CDC does not give an estimate of how many health care workers are HIV-positive -- of the total number of HIV cases reported through 1999 for which an occupation is known, about 5% were from individuals employed in the health care industry (AP/San Jose Mercury News, 4/1).