Is it legal to require HIV testing of every patient in the dialysis unit?

It's difficult to answer your question. Different countries or U.S. states may have laws pertaining to testing of people for HIV. There has long been concern about employer and insurance discrimination related to testing for HIV. Therefore, to educate people about high risk behaviors, to prepare them emotionally in case the test is positive, and to protect people from discrimination, advocates have long argued for pre-test/post-test counseling, the right to remain anonymous, and the right to confidentiality of test results.

It is a common medical practice that people are allowed to accept or refuse medical procedures. This does not prevent someone from asking your permission to test you. However, in the U.S., routine HIV testing has not been considered necessary for those who do not have symptoms or are not in groups considered to be at high risk of exposure.

Several years ago, the U.S. Office of Civil Rights became involved in a case when an HIV positive patient was refused dialysis for a trip. This led clinics to reexamine their policies.

Check with your state health department to see what the laws are in your state for HIV testing. You may also want to read the National Kidney Foundation brochure on infectious diseases: www.kidney.org/general/atoz/content/infectdisease.html.

The U.S. Centers for Disease Control and Prevention (CDC) that recommends policies and procedures to prevent the spread of diseases recommends that:
1) Dialysis staff should practice "universal precautions" on ALL patients to limit their exposure to blood-borne diseases, like HIV.
2) Dialysis machines, chair, etc. should be disinfected between patients using a certain concentration of bleach water (bleach kills HIV).
3) Patients with HIV can do either hemodialysis or peritoneal dialysis.
4) Patients on hemodialysis do not have to be isolated from other patients and their dialyzers can either be thrown out after each use or be reused but only on that patient.

item #3 needs to be addressed. It is not recommended that a person with HIV have a permanent catheter placed into their body. This is a harbor for infection. Seen it too many times. HIV is a chronic disease not an intermittent one, therefore a patient's immune system is always under attack. Temporary catheters are encouraged until graft or fistula is mature.

Hemodialysis catheters are associated with a higher risk of infection, and it's my understanding that HIV patients are at even greater risk of infection due to their compromised immune system. Any patient who has a hemodialysis catheter faces a higher risk of hospitalization and even a higher risk of death than a patient with a graft or fistula. In fact, according to the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative guidelines, the fistula is the best type of vascular access for dialysis because of its lower rate of complications.

So far as peritoneal dialysis and HIV is concerned...Here is a link to an article by recognized authorities in peritoneal dialysis that you might want to read. It reviews the literature and compares hemodialysis and peritoneal dialysis, including information specifically on HIV. See http://www.uninet.edu/cin2001/html/conf/oreopoulos.html.

This article states that HIV patient survival on CAPD is at least as good as his/her survival on hemodialysis. However, staff and HIV patients alike need to be especially watchful of peritonitis and protein loss as these are even greater risks in those with HIV because of their compromised immune system.

do you have a link in english? I don't habla much in espanol anymore.

The link in the email above didn't work because there was a period at the end of the sentence that somehow was hyperlinked. I've included the correct link below.

The abstract looks like it's going to be in a foreign language because the conference where it was presented was an international one. In actuality, the abstract is in English, but you need to scroll down the page to get to it.

I don't recognize the names of the other authors, but Dr. Oreopoulos from Canada is a well respected expert with a long history working in peritoneal dialysis.
www.uninet.edu/cin2001/html/conf/oreopoulos.html

I did review the doctors study but according to his morbidity rates I should have died in 1997-98. Exit sites are a issue for HIV patients and temp catheters when pulled by the HD clinic are becoming the challenge to send off to lab to check for infection due to nursing shortage and budgeting for the clinic. Several times when pulled by the clinic a argument ensues by the RN stating "I CAN TELL IF A CATHETER OR AN INFECTION IS PRESENT, I DON'T NEED A LAB TO SEE THIS". Information always comes back infected.