Should surgical patients be screened for human immunodeficiency virus infection?

There are increasingly strong arguments for the introduction of wider screening of all kinds of patients, including surgical patients, to diagnose otherwise undetected human immunodeficiency virus (HIV) infection in order to facilitate earlier treatment of HIV infection with zidovudine. Wider screening may also help to limit the spread of HIV in the community as infected patients may be counselled and more effective public health measures planned. In areas of high prevalence voluntary universal screening test programmes should be encouraged whereas in areas of low to medium prevalence more selective screening tests would be appropriate on people belonging to risk groups. Screening of patients undergoing elective surgery for infection control purposes is most appropriate in areas of low to medium prevalence so that extra precautions in the operating theatre can be selected for those patients who are screened and deemed to be at high risk. Screening methods include taking a comprehensive clinical history to include specific questions about risk group behaviour, questionnaire methods, serological screening tests and a combination of these three types of approach. Screening HIV antibody tests are recommended, with informed consent, of those patients who belong to risk groups. A further benefit of screening for infection control purposes occurs in the event of a sharps injury when prior testing of the source patient helps to facilitate decision making about the giving of immediate zidovudine prophylaxis.