Ban lifted on HIV-positive dentists


The ban on HIV-positive dentists practising dentistry is to be lifted from April 2014, the government announced today (Thursday).
The move by the Department of Health (DH) to remove the restriction on HIV-positive dentists, along with other healthcare workers, has been welcomed by key people within the dental profession.
Following independent scientific advice, the DH will lift the ban on healthcare workers with HIV being able to carry out certain dental and surgical procedures. 
Strict rules on treatment, monitoring and testing will be in place to safeguard patients.
This change will bring the UK in line with most other western countries. 
Under the new system, patients will have more chance – around one in five million – of being struck by lightning than being infected with HIV by a healthcare worker. 
There is no record of any patient ever being infected through this route in the UK and there have been just four cases of clinicians infecting patients reported worldwide and the last of these was more than a decade ago.
The changes announced today could reduce that risk even further because healthcare workers will be more likely to get tested themselves and therefore less likely to potentially put people at risk.
The British Dental Association (BDA) called it a 'victory for common sense', saying it reflects the fact that, globally, over the past 20 years no dental professional has been linked with the transmission of HIV infection to a patient.
It also cites the fact that huge advances in anti-retroviral treatment mean that the 
virus can be suppressed to the point where it is undetectable in a blood test. 
Kevin Lewis, dental director at dental defence organisation, Dental Protection, also welcomed the new ruling.
He said: 'This is a huge victory for human rights. After decades of living in fear and dealing with prejudice, dentists can finally return to their professional calling, although regrettably it is too late for some to do so. 
'Patient safety should be at the forefront of healthcare, but the original rules were introduced as a reaction to a mysterious and exceptional case, the likes of which we have not seen before or since.'
The Department of Health's change in policy is based on an expert assessment by a Tripartite Working Group of the accumulated evidence from around the world on the negligible risk of transmitting HIV from an infected healthcare worker to a patient.
Today's announcement indicates that HIV-positive healthcare workers who return to clinical duties will be required to demonstrate that they are on combined anti-retroviral treatment, must have achieved undetectable levels of the virus and will be subject to regular monitoring.
The BDA’s scientific adviser, Professor Damien Walmsley, said: 'Under the current regulations, being HIV-positive effectively brings a dentist’s career to an end. That is a tragedy for the individual practitioner and an unnecessary waste of the taxpayers’ money invested in their training. Despite extensive investigation, no case of HIV transmission from a healthcare worker to a patient has ever been identified in the UK.'
He added: 'That is unsurprising. Dentists in the UK comply with rigorous infection control procedures to protect both patients and the dental team against the risk of transmission of blood-borne infections. 
'The revised policy announced today, which brings England into line with nations including Sweden, France, Canada and New Zealand, is good news for patients and HIV-positive dentists alike. We look forward to seeing its implementation.'
Decided on a case-by-case basis, HIV-infected healthcare workers may be allowed to undertake certain procedures, if they are:
* On effective combination antiretroviral drug therapy (cART)
* Have an undetectable viral load
* Are regularly monitored by their treating and occupational health physicians.
The change in policy will also allow people to buy HIV self-testing kits once the kits comply with regulations.
Both policies will be in place from April 2014. Public Health England will now put in place a programme to register and monitor healthcare workers who have HIV and ensure they are able to perform certain procedures when appropriate.
The BDA and Dental Protection have lobbied for the last decade against rules that prevent HIV infected dentists from pursuing their professional vocation.
The regulations were brought in after the publicity associated with the death of an American dental patient in 1990, one of six patients believed to have been infected with HIV in an unresolved Florida case. 
Regulatory bodies in most countries responded to the case differently – the UK banned all HIV-infected healthcare professionals from undertaking exposure-prone procedures, leading to health workers becoming deskilled, losing their careers, or suffering in silence. 
Since most dental procedures are classified as exposure prone, the ban had a devastating significance for dentists diagnosed with the disease.
There have been two major developments since the rules were put in; anti-retroviral therapy, which is effective in lowering the viral level for patients with HIV, and improved infection control standards. 
Together these mean that it is safe for a dentist with the disease to return to work provided they comply with the conditions of the new regulations.
* BBC's Today programme will be carrying an interview with a dentist who has affected by the existing ban.

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