Reply by the Authors of the Original Article

Regarding “High-Risk Cardiac Surgery in Patients with Intravenous Drug Abuse and/or Active Hepatitis C or Human Immunodeficiency Virus Infection: An Ethical Discussion of Six Cases”

Prevention of Seroconversion after HIV-Infected Needle Stick

We are really honored to be subject of the interest of Prof. Robicsek, a living legend of cardiothoracic surgery, about our letter and the related major article.[1]

The management of human immunodeficiency virus positive (HIV + ) bleeding patients is complex not only on account of the active bleeding but even more for the possible transmission of retrovirus, as also shown in the article by Gansera et al[2] and in all the commentaries regarding this issue presented in the journal “The Thoracic and Cardiovascular Surgeon.”

In the unfortunate event of a needleprick injury in an HIV+ patient, we routinely adopt in the first instance the procedure suggested by Prof. Robicsek that has shown to be able to reduce transmission of retrovirus in these cases.

However, we personally trust mainly the prophylactic administration of antiretroviral therapy and continuous surveillance.[3]

We consider effective prevention is the best method to avoid the risk of occupational HIV transmission. Protections/precautions, adoption of mini-invasive surgical techniques, mandatory preoperative HIV testing, and, sometimes, conservative treatment are the four pillars of this strategy.

Despite them, we must admit that any surgery on HIV+ bleeding patients induces distress and fear to the nursing and medical staff, even to the most trained one.

The highest risk of exposure occurs when blood loss exceeds 300 mL or in case of major cardiovascular or intra-abdominal surgery.[4]

• References

• 1 Domanin M, Romagnoni G, Romagnoli S, Rolli A, Gabrielli L. Emergency hybrid approach to ruptured femoral pseudoaneurysm in HIV-positive intravenous drug abusers. Ann Vasc Surg 2017; 40: e5-e12
• 2 Gansera LS, Eszlari E, Deutsch O, Eichinger WB, Gansera B. High-risk cardiac surgery in patients with intravenous drug abuse and/or active hepatitis C or HIV infection: an ethical discussion of six cases. Thorac Cardiovasc Surg 2016; 64 (01) 2-5
• 3 Gerberding JL. Clinical practice. Occupational exposure to HIV in health care settings. N Engl J Med 2003; 348 (09) 826-833
• 4 Gerberding JL, Littell C, Tarkington A, Brown A, Schecter WP. Risk of exposure of surgical personnel to patients' blood during surgery at San Francisco General Hospital. N Engl J Med 1990; 322 (25) 1788-1793