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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 1994  |  Volume : 5  |  Issue : 2  |  Page : 202
The authors reply


Consultant Nephrologist, Tawam Hospital, Al Ain, Abu Dhabi, United Arab Emirates

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How to cite this article:
Boobes Y. The authors reply. Saudi J Kidney Dis Transpl 1994;5:202

How to cite this URL:
Boobes Y. The authors reply. Saudi J Kidney Dis Transpl [serial online] 1994 [cited 2020 Apr 7];5:202. Available from: http://www.sjkdt.org/text.asp?1994/5/2/202/41350
We agree with Dr. Hijazi that the bio­statistics in the under developed countries are still very poor. However, as long as there is no data available we cannot make any conclusion based only on our assum­ptions. The incident mentioned by Dr. Hijazi is very serious. In this incident the cause of HIV transmission was reusing some of the dialysis disposables several times for different patients. We are aware of a similar incident that occurred in Argentina. According to a report in BMJ, five Argentinean doctors have been accused of allowing patients to be dialyzed using reused dialysers from HIV-infected patients [1] . At least 20 of the 34 patients treated in one center (Centro Modelo de Dialisis) have been infected with the virus.

The cause of HIV transmission in both incidents was using contaminated materials. This is a non professional act and could be considered a criminal act where the minimum norms of biosafety are not respected (in the Argentinean incident the judge considered the five doctors working in that unit as culpable). So, this is out of our discussion. In our article we tried to say clearly that the transmission of HIV in dialysis units is unlikely to happen if routine infection control precautions are followed: "The possibility for this in the future also appears to be extremely unlikely, provided that routine infection control precautions are followed". When the issue of HIV transmission by dialysis is addressed, it means mainly the transmission that occurs due to dialysis itself, vertical (patient-machine-patient) or horizontal (patient-patient) by usual contacts. Both the above mentioned incidents are not such cases. Using contaminated materials certainly will transmit the disease in any kind of treatment, whether it is dialysis or any other. If a patient is transfused with contaminated blood during dialysis he will quite definitely contract the disease. However, one cannot consider that the disease was transmitted by dialysis. For these two reasons the quoted incident by Dr. Hijazi does not support his conclusion that "Transmission of HIV through haemodialysis can happen and must be considered seriously." However, we prefer to say: "Transmission of HIV through haemodialysis could happen and must be considered seriously".

Concerning the second comment, to evaluate the risk of occupational trans­mission of HIV it is preferable to study the incidence of transmission as a function of exposures. This will reflect better the real risk. The conclusion of reports cited by Dr. Hijazi that "occupational transmission is a possibility which should not be under estimated, but meanwhile should not defer HCW from providing medical care to AIDS patients" is in agreement with our article. And again, this is not because of high incidence, (these reports show a possible incidence around 5.5/10000) but because it is a fatal disease.

Also we agree with the information given by Dr. Hijazi about the prophylactic use of azidothymidine.

Finally, when we discuss such a serious disease we have to be objective and not subjective. Although personally we do prefer to use a separate dialysis machine for HIV positive patients for more safety, however there is no report in the literature to support this concept as a mandatory policy. Whether the patients will accept that or not is another issue, and for this reason we said "the decision to isolate and whether or not to use a separate dialysis machine should be individualized according to locally prevailing factors". On the other hand, the experience in Europe and other endemic countries contradicts any generalized state­ments like "the idea of using the same dialysis machines for all patients will never be acceptable to other ESRF patients".[1]

 
   References Top

1.Dyer E. Argentinian doctors accused of spreading AIDS {news} BMJ. 1993;307:584.   Back to cited text no. 1    

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Correspondence Address:
Y Boobes
Consultant Nephrologist, Tawam Hospital, Al Ain, Abu Dhabi
United Arab Emirates
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