Hopkins doctor did not pass AIDS to patients, tests confirm

April 14, 1993|By Douglas Birch | Douglas Birch,Staff Writer

Advanced genetic testing has confirmed that Dr. Rudolph Almaraz, a Johns Hopkins Hospital surgeon who died of AIDS in November 1990, did not pass the disease on to any of his patients, medical investigators say.

In an article in today's Journal of the American Medical Association, the investigators said the risk of an HIV-positive surgeon infecting a patient on the operating table is less than one infection for every 1,000 hours of surgery.

An editorial in the Journal, however, cautions that the studies don't rule out the possibility that there are "particularly infectious" surgeons or dentists who can cause "clusters" of HIV cases.

The authors of the editorial cite the case of Dr. David Acer of Florida, who is thought to have infected five patients in his dental office, including the late Kimberly Bergalis.

So far there are no reported cases of a surgeon passing the disease on to a patient. Dr. Acer is the only dentist thought to have done so.

The state health department, Hopkins and the U.S. Centers for Disease Control first reported in December 1991 that Dr. Rudolph Almaraz probably did not infect any of the 1,800 patients he treated during the six years he spent at Hopkins.

An investigation began in December 1990 after The Sun reported that Dr. Almaraz, who specialized in breast surgery, had died of an AIDS-related illness at his home in Parkton.

Two of Dr. Almaraz's patients were later found to have contracted the virus. But both were suspected of having caught the disease from separate transfusions of HIV-contaminated blood.

Dr. Audrey Smith Rogers, the lead author of the study, told reporters in Baltimore yesterday that investigators used advanced DNA testing to compare the genetic structure of the AIDS virus found in Dr. Almaraz, his two HIV-positive patients and the contaminated blood the patients received.

HIV is a rapidly mutating virus, and the precise structure of its genetic material typically varies widely among infected individuals.

Dr. Rogers said tests at the University of Edinburgh, Scotland, showed that the viruses found in the patients were similar to the viruses found in the samples of the blood used for transfusions.

Scientists concluded it was "substantially more likely" that the patients were infected by the transfusions than by Dr. Almaraz.

The Baltimore study, which cost $103,600, is one of three in today's Journal that studied the patients of health care workers with AIDS. Altogether, the authors of the articles reviewed the medical histories of 2,555 patients who were treated by two HIV-positive doctors -- Dr. Almaraz and an orthopedic surgeon from New Hampshire -- and one Florida dentist who was not Dr. Acer.

None of the three studies found a single patient who was infected during surgery or other invasive medical procedures.

But in a Journal editorial, Dr. William Schaffner and Dr. Ban Mishu of Vanderbilt University point out that some of the patients in the three studies may have been HIV-positive, but had not been tested or were unwilling to cooperate.

They also warn that doctor-to-patient HIV infections may follow the same pattern as doctor-to-patient hepatitis B virus infections.

With hepatitis B, most infected doctors and dentists do not transmit the virus to patients.

But a few seem to be extremely infectious, passing the virus along even when they use double gloves and follow strict antiseptic procedures.

Other doctors, though, point out that HIV often behaves in a different way than hepatitis B. It is, for example, 1,000 times more difficult to transmit HIV than hepatitis B. HIV dies relatively quickly when exposed to air, doctors say, while hepatitis B is far heartier.

Dr. Rogers said that Dr. Almaraz had operated on 1,131 people at Hopkins. By the time the study began, 101 had died, though none of the deaths was found to have been caused by AIDS. Another 200 could not be located.

The state health department eventually sent letters to 830 individuals and received 551 responses. Of those responding, 356 said they had been tested for HIV and disclosed the results of those tests.

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