The HIV positive dentist in the United Kingdom – the dilemma of the undiagnosed clinician

Abstract

Since the time of Dr Acer, the introduction of highly active anti-retroviral therapy (HAART) has led to a dramatic decline in morbidity and mortality among patients infected with HIV. 14 In the United Kingdom, HIV/AIDS has been transformed from being a fatal disease to a chronic illness. 15 Antiretroviral therapy can reduce HIV type 1 viraemia to below the detection limit of ultra sensitive clinical assays (50 copies of HIV-1 RNA/ml). 16,17 Viral load is the chief predictor of risk of heterosexual transmission of HIV-1 and it is known that transmission is rare among persons with levels of less than 1,500 copies of HIV-1 RNA per millilitre. 18 Recent studies support the non-transmissibility of the disease from individuals effectively treated with ant-retrovirals. 19,20 The 2009 Beijing Declaration supports the view that oral healthcare professionals with HIV do not pose a risk of transmission to patients in the dental setting, providing: • The individual is under ongoing care by a suitably qualified HIV health care professional • The individual remains aware of his/ her health status and acts appropriately • Standard infection control is observed • Scientific evidence related to HIV transmission continues to be reviewed. 21 Some European countries now allow HIV positive dentists to work. 22 The current UKAP guidelines are under review, 23

No longer 'written off' – times have changed for the BBV-infected dental professional

“…This original correspondence spawned a succession of letters and comments over several years in the British Dental Journal in support of changes to the guidance. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Since David Croser's paper in 2006 1 there have been a number of incremental changes to guidance which significantly improve the outlook for BBV-infected healthcare workers (HCWs), including dentists, whose work involves EPPs. In particular the outcome of the work of the UK Department of Health Tripartite Working Group, which included members from the Advisory Group on Hepatitis (AGH), the Expert Advisory Group on AIDS (EAGA), the UK Advisory Panel for Healthcare Workers infected with Blood-borne Viruses (UKAP), the Department of Health (DH), the National AIDS Trust (NAT) and other outside experts provided a persuasive case for amendment of the guidance on HIV infected HCWs.…”