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Injuries and contact with blood during surgical procedures.1 2 At present the use of “universal precautions” is encouraged through all surgical procedures,three four but anecdotal evidence suggests that most surgeons use such measures only in the event the patient is known to be HIV positive. We investigated how common it was for operations to become carried out on HIV positive sufferers in Leeds prior to their HIV status had been determined. A retrospective case note evaluation was carried out for all 260 patients with HIV infection who had been frequently followed up in our PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20100031 department in OICR-9429 site between 1984 and 1997. Operations performed within the three years before the diagnosis of HIV infection have been scrutinised and documented only in the event the patient was likely to possess been HIV constructive at the time of surgery, taking into consideration the CD4 count at diagnosis. We located that 24 patients had undergone a total of 28 operations beneath basic anaesthesia (table). Twenty two in the procedures were elective and six were emergencies. Surgeons had thus been operating on individuals who, unknown to them, had been HIV constructive. Admittedly, these cases represented only a smaller proportion of all operations performed, however they incorporated important procedures such as thoracotomy, laparotomy, and hysterectomy. None from the sufferers had been recognised in the time of operation as getting at high risk of HIV infection. Some surgeons think that routine preoperative HIV testing of sufferers would decrease the dangers to staff, but this strategy has various practical difficulties. Preoperative HIV testing is clearly impractical just before emergency procedures, although for elective surgery a damaging result of a test could be falsely reassuring because of the delay to the”Source testing” need to be allowed Editor–Management after occupational exposure to HIV has ranged from no action towards the use of single agent zidovudine, and now the Department of Wellness has suggested triple therapy.1 In their editorial Easterbrook and Ippolito2 raise the challenges of recommendations based on indirect proof including a retrospective case-control study,3 animal models, biological plausibility, along with the use of zidovudine to minimize the danger of vertical transmission. All this perform is primarily based on the use of zidovudine as a single agent. Within the light of current practice this has been extrapolated to recommendations primarily based on triple drug regimens. Easterbrook and Ippolito sound a note of caution regarding the usage of toxic drug regimens and point out that the American recommendations advocate triple therapy only for high danger exposures or when drug resistance is suspected whilst the British guidelines recommend it for all substantial exposures. This divergent suggestions makes it even tougher to present consistent suggestions to healthcare workers who are confused by the debate. Any one who has had private experience of a needlestick injury, or has had to cope with such scenarios, knows how difficult a time that is to take in any information, let alone conflicting details, and come to a rational choice. One particular challenge that in my view has not been satisfactorily resolved by the recommendations is definitely the issue of “source testing.” The inability to figure out the HIV status of the supply patient devoid of getting informed consent wastes time inside the delivery of prophylaxis, adds uncertainty for the counselling procedure, and encourages the (possibly unnecessary) use of toxic and pricey drugs. The time has come to get a nationally coordinated helpline to be produced obtainable by the Division of.