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CORRESPONDENCE SECTION |
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| Year : 2003 | Volume
: 20
| Issue : 1 | Page : 73 |
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Routine HIV testing - the need for a rationalized approach
Anindya Chattopadhyay
Department of Pediatric Surgery, Kasturba Medical College, Manipal, India
Correspondence Address:
Anindya Chattopadhyay
Department of Pediatric Surgery, Kasturba Medical College, Manipal
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Chattopadhyay A. Routine HIV testing - the need for a rationalized approach. Indian J Urol 2003;20:73 |
The letter titled "Routine HIV testing in urologic patients: is it desirable?" (Indian Journal of Urology 2002, 19:93-5) is a timely and frank reflection of the views of the surgical community towards the increasing proportion of patients with HIV. However, the argument that routine testing of patients with or without their consent will help to reduce the transmission of the disease seems to be self serving.
It has generally been agreed that the best approach to containing the HIV infection is spreading of awareness. Unfortunately, the medical fraternity's own record of awareness has been poor. A recent article from Mumbai points out that most residents and surgeons are unaware of the rates of transmission, body fluids that pose risks, drugs used for postexposure prophylaxis and their side effects among others. [1] This lack of awareness often translates into heightened anxiety and the desire to screen all patients with whom contact is likely.
The fact that universal precautions seem to be the only way to safeguard oneself from risk also seems not to have penetrated the psyche of our medical fraternity. The risks of exposure during the window period are real, as also the risk of exposure during emergency procedures and laboratory procedures. In addition to HIV, universal precautions also serve to protect against Hepatitis B (HBV) and Hepatitis C (HCV). Adding specialty specific recommendations such as the use of hands free passage of instruments and common sense in the operating rooms will also help to reduce the risk of transmission.
Although the exact numbers of health care workers who have seroconverted after an occupational exposure is difficult to determine, a study from Taiwan (where the prevalence of HIV is around 0.8%) estimated the risk of contracting HIV from a hollow needlestick injury was extremely low, and the category of workers most exposed to the risk were the nursing staff. [2] A study from neighboring Pakistan shows that the rates of HBV and HCV among Health Care Workers (HCW) are very high, and HIV prevalence is nil. [3] This again underscores the need for implementing universal precautions, especially among the nursing staff and residents.
The authors rightly pointed out that there has been an alarming increase in the prevalence of seropositivity. Tamilnadu, Karnataka and Maharashtra appear to be the worst affected with prevalence rates of around 2%. Unfortunately the prevalence of HBV is about three fold higher and its transmissibility far exceeds that of HIV.
The authors also seem to miss the point about patients who test positive for HIV. The ethical issue that surrounds a false result is negligible compared to the social and emotional ostracism that the truly positive patient is subjected to. Without adequate facilities for counselling and care. the fate of the HIV-positive patient in India is pitiable. This is the principal drawback of uncounselled testing, which also violates the patient's right to privacy.
And lastly as the doctors also form a substantial percentage of the population, should not the patient also demand to know the HCW's HIV status before subjecting himself for treatment? Definitely, a more measured approach with awareness, education and inculcation of the universal precautions at the medical curriculum level seem to be the best method of safeguarding oneself. Incidentally, even in countries with extremely high prevalence such as Nigeria, this is the approach that seems to have been adopted.
 References | |  |
| 1. | Chogle NL, Chogle MN, Divatia JV. Dasgupta D. Awareness of postexposure prophylaxis guidelines against occupational exposure to HIV in a Mumbai Hospital. Natl Med J India 2002: 15: 69-72.  |
| 2. | Shiao J. Guo L. McLaws ML. Estimation of the risk of bloodborne pathogens to healthcare workers after a needlestick injury in Taiwan. Am J Infect Control 2002: 30: 15-20. |
| 3. | Aziz S. Memon A, Tily HI, Rasheed K. Jehangir K, Quraishy MS. Prevalence of HIV, hepatitis B and C amongst health workers of Civil Hospital Karachi. J Pak Med Assoc 2002; 52:92-4. |
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