Abstract
According to the Manual for Medical Examination of AIDS Patients by the Ministry of Health and Welfare, hemodialysis of HIV antibody-positive patients is classified as an operative procedure (level III). In this manual, the preventon of HIV infections in hemodialysis is also described. However in reality, no institution in Japan has ever performed hemodialysis on an AIDS patient. Therefore, procedures for the hemodialysis of such patients have yet to be established here.
The patient, a 46-year old female, had been receiving hemodialysis since May 1980. She had been receiving washed cell transfusion for anemia and also received a large blood transfusion for an operation for cancer of the cervix in March 1985. Laboratory examination in May 1987 showed that HIV antibody and antigen were positive, and she was transfered to our hospital. In September 1987, it was also confirmed in our hospital that HIV antibody and antigen were positive. Diarrhea and oral candidiasis appeared on October 5, and were healed by treatment with an anti-fungial drug. After she entered our hospital far high fever on October 21, disturbance of consciousness and clonic cramp appeared, and she died of an unknown cause on November 2, 1987.
We performed hemodialysis on this HIV infected patient by means of a dedicated hemodialysis machine located in a separate part of the hemodialysis room partitioned off by curtains. We used the gown technique and goggles during blood access and at the end of hemodialysis. Since the most dengerous accident for HIV infection is a stab wound from a contaminated needle, we put the needles into a polyethylene bottle immediately after the punctureing her shunt. During hemodialysis, injections were performed by a infusion or an air trap line of the circuit without a needle. Disposable products were discarded after machanical sterilization, and the machine, bed and floor of the room were sterilized with sodium hypochlorite and alcohol.
This patient apparently suffered from AIDS and died with in a short period of time. We have had valuable experience in establishing a guidelines for the hemodialysis of AIDS patients in our hospital.
