Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 1994  |  Volume : 5  |  Issue : 2  |  Page : 200--202

The Kidney and HIV Infection


Ali Hijazi 
 Department of Cardiothoracic and Transplantation Surgery, Hamad Medical Corporation, Doha, Qatar

Correspondence Address:
Ali Hijazi
Head of Cardiothoracic and Transplantation Surgery, Hamad Medical Corporation, P.O. Box 3050, Doha
Qatar




How to cite this article:
Hijazi A. The Kidney and HIV Infection.Saudi J Kidney Dis Transpl 1994;5:200-202


How to cite this URL:
Hijazi A. The Kidney and HIV Infection. Saudi J Kidney Dis Transpl [serial online] 1994 [cited 2020 Aug 11 ];5:200-202
Available from: http://www.sjkdt.org/text.asp?1994/5/2/200/41349


Full Text

With interest I read the article "The Kidney and HIV Infection" by Boobes et al in Saudi Kidney and Transplantation Bulletin, Vol. 4, No.3 December 1993. The article is very informative and provides straight facts about the subject. However, as our knowledge at the moment about Human Immunodeficiency Virus (HIV) is still incomplete and with many an uncertainty waiting satisfactory explanations, I would like to make the following comments.

In the abstract of the article it says in line 12 "although there has been no report yet about transmission of HIV by dialysis, a theoretical possibility exists although quite low". I believe this statement is probably true for the western world, but quite unrealistic for many developing and under developed countries where bio-statistics either do not exist at all or are very poor. Therefore many interesting medical condi­tions go unreported.

It is my knowledge that in June 1993 there was an outbreak of HIV infection in a dialysis unit in one of the developing countries, where 18 patients got exposed to the deadly virus. All were found sero­positive, later. This incident was reported by most of the major news papers of that country. The news about the outbreak was later confirmed by an official report from the Ministry of Public Health of that country. The investigation committee reco­mmended urgent introduction of a number of new laws to prevent similar incidents from happening in the future. I believe the incident has not yet been published in the medical literature, therefore I will briefly mention some of the details.

A native of the country in question, who was working abroad was diagnosed to have acquired HIV infection in the country where he was working. He returned home, when he developed end stage renal failure. The law of his native country required that all new haemodialysis patients must undergo serological survey and produce a certificate of freedom from transmissible diseases before they are accepted for regular treatment with haemodialysis. But, as it may happen in any third world country, this expatriate was able to obtain a falsified certificate from a private laboratory. He got accepted for haemodialysis and was repeat­edly dialyzed. The sad point is that due to the shortage of resources and adequately trained staff, some of the disposables used in dialysis were not discarded but were reused several times and that too, for different patients. This is how other unfortunate dialysis patients got the virus. I hope some one interested in these units will publish the incident in the medical literature. My conclusion is that trans­mission of HIV through haemodialysis can happen and must be considered seriously.

The second comment is about the occupa­tional transmission of HIV. I am quite aware of many reports and studies published by Center for Disease Control (CDC) [1] , American College of Surgeons [2] and others [3] which all state low incidence of such transmission, but careful analysis of these reports throw some doubt about the accuracy of these statements. For instance, in surgical practice, the published reports do not give satisfactory details about the type of injury and the amount of contamination [4] . As we know, a puncture with a hollow needle is different from one inflicted by solid needle. The same is true with the disease stage and viral titers in the patient's blood.

An article that appeared recently in the Bulletin of the American College of Surgeons shows that the CDC estimates that out of the 4.5 million health care workers (HCW) in the US, 360 surgeons, 1200 dentists, 5000 physicians and 35000 other HCW are HIV infected and many of these are either symptomatic or unrecognized [5] . Over 94% of HCW appeared to have acquired the infection by non-occupational exposure, the remaining 6% is undeter­mined, but likely to be due to occupational exposure [5] . According to these reports occupational transmission is a possibility which should not be underestimated, but meanwhile should not defer HCW from pro­viding medical care to patients with Acquired Immunodeficiency Syndrome (AIDS).

The effectivity of precautions and preventive measures is still unclear, but still these must be strictly followed. As with regard to the prophylactic use of azidothymidine (Zidovudine) in the exposed personnel, again this is done on purely empirical and speculative basis [6] . I would like to mention that Wellcome Foundation, UK, the manufacturing company of Zidovudine, has stated that patients should be advised that Zidovudine has not been shown to reduce the risk of transmission of HIV to others through sexual contact or blood contamination.

In addition, the co-ordinating committee of the Anglo-French Concord trial of Zidovudine in symptomatic HIV patients, has not shown any significant benefit [7] . Other studies reported similar conclusions, nevertheless some of them found that Zidovudine protects against the fall in CD4 [8] . After the use of Zidovudine there is a short lived increase in the CD4 cell count and decrease in the P24 Antigen. This may bring some clinical improvement in symptomatic patients. However, this is still a controversial subject and needs further investigations. One should also remember that Zidovudine is not free of side effects [6] .

The idea of using the same dialysis machines for all patients will never be acceptable to other ESRF patients who have enough problems, without adding the fear of acquiring Aids. The future for AIDS looks very gloomy for the time being. I hope a cure is found soon.

References

1Centers for Disease Control. Recommendations for prevention of HIV transmission in health-caresettings. MMWR 1987;36(S2):1-18.
2Rhodes RS. The Committee of AIDS. Bull Am College of Surg. 1992;77:12.
3Bell DM. Human immunodeficiency virus transmission in health care settings: risk and riskreduction. Am J Med. 1991;91(3B):294-300.
4Tanner AG. HIV infection-the problems of surgery in infected patients. Post Graduate Doct. 1993;16(2):44-50.
5Rhodes RS. HIV and the surgical team. Bull Am College of Surg. 1993;78:2.
6Tokars JI, Marcus R, Culver DH, et al. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV­infected blood. The CDC Cooperative Nee-dlestick Surveillance Group. Ann Intern Med. 1993;118(12):913-9.
7Aboulker JP, Swart AM. Preliminary analysis of the Concorde trial. Concorde Coordinating Committee. Lancet. 1993;341(8849):889-90.
8Vella S, Giuliano M, Dally LG, et al. Long-term follow-up of zidovudine therapy in asymptomatic HIV infection: results of a multicenter cohort study. The Italian Zidovudine Evaluation Group. J Acquir Immune Defic Syndr. 1994;7(1):31-8.