Friend is HIV+ applicant -- disclose or not disclose?

[inhiding]

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I don't think they would have kicked you out if you were HIV positive however.

Actually, I believe it's illegal to kick out a student for being HIV+. I think they are protected by law.

And VneZonyDostupa -- isn't a high CD4 cell count good??? 😕😕😕

 

[VneZonyDostupa]

And VneZonyDostupa -- isn't a high CD4 cell count good??? 😕😕😕

Yeah, it is. Did I ever say it wasn't?

A high, but not normal, count, means there is something suppressing it, but yes, a high count is better than a low one.

 

[ElZeekio]

Sorry, I just gotta butt in on this thread. I am *shocked* at the level of ignorance shown on here by a minority of the commenters. Thank God most of you are educated about one of the world's largest epidemics. As a physician, you need to treat everyone as though they're infected with everything under the sun, this is called universal precautions. This does not mean that you treat anyone as though they are a leper! This person is not looking for career advice from you, nor your opinions on HIV+ physicians, as stated over and over, but for advice about how and when to disclose. So just keep yer traps shut about whether you think he should do it or not! There are many physicians with chronic illnesses, including HIV, out there. Some are open about it, others are not. In the end, it's up to each individual and their own physician to determine how to move forward, not a bunch of random strangers on the internet.

HIV is not the death sentence it was 15 years ago. HIV is not AIDS. HIV is a chronic, treatable infection. Look at the highlights from this year's AIDS conference in Mexico City. Stop using the Enquirer for your "facts" about HIV and start using PubMed.

In addition to the other links provided, here is the American College of Surgeon's view on surgeons with HIV:
http://www.facs.org/fellows_info/statements/st-13.html

www.thebody.org is a great resource for knowing more about this disease, HOW IT IS CONTRACTED, its treatments and how it affects those people who have it. Perhaps some of you posters should check it out before making more erroneous comments which belie a world of ignorance.

Your friend may also want to talk to an Occupational Health Physician about his circumstances. I would not disclose such status, nor any disability or health condition, to the adcom. If I were on the adcom, I would consider this "oversharing" as the kids say today. It raises more questions than it answers, too. This information should be provided to the Occupational Health team at the hospital, and does not need to be shared with anyone else unless advised otherwise by the occupational health team.

 

[smq123]

No, "a lot" of HIV+ individuals do not have normal CD4 counts. They may have high counts, but not normal.

😕

This doesn't even make sense. If you have a "high" count, then that IS normal. As long as it's over 500 (some people say 450), then it's normal.

In my experience, a lot of the HIV+ patients I saw in outpatient clinics had normal (between 500-1000) CD4 counts. If you have any resources that confirm that this is not the norm, then please post them.

HAART is only as effective as the patient is at taking it. If you miss a few doses, you can build a drug resistance and will have to switch to another therapy, which may or may not work for you. I've seen plenty of patients have horrible reactions to certain drugs, and I've seen patients who switch to anew regimen only to find out that their specific infection is already resistant to it.

They switch, and THEN they find out that it's a resistant strain?

They don't do resistance testing up in your region of the country? That's odd.

And while it's true that HAART is only as effective as the patient taking it, the same is true of insulin. Does this mean that diabetics shouldn't be allowed into medical school? Remicade is only as effective as the patient taking it, so does that mean that people with Crohn's and psoriasis shouldn't be allowed into med school either?

Like I said - it is NOT up to us to decide if he's fit for med school or not. That depends on the person and his ID specialist who takes care of him. Assuming that he's not compliant, assuming that his HAART regimen doesn't work, and assuming that his CD4 count is low is unfair to him.

I think you clicked on the wrong forum. This is called the "Pre-Allopathic" forum, meaning most people on here are "pre-med". No worries, I'm sure your ego just got in the way when you were trying to click on the Allopathic forum.

<sigh>

My incredulous tone of voice had nothing to do with my ego.

It had more to do with the fact that your post sounded confident, as if you knew what you were talking about. This made me think that you were in med school.

Which is why I couldn't understand why your post had so much incorrect information in it. That's all.

 

[inhiding]

^ Quote from the first link from ElZeekio:

"Based on data in the current literature, HIV-infected surgeons may continue to practice and perform invasive procedures and surgical operations unless there is clear evidence that a significant risk of transmission of infection exists through an inability to meet basic infection control procedures, or the surgeon is functionally unable to care for patients. These determinations are to be made by the surgeon's personal physician and/or an institutional panel so designated for confidential counseling. Such a panel should be composed of infectious disease specialists, surgeons, and other health care professionals who are knowledgeable about blood-borne infections."

If it's good enough for the American College of Surgeons, it's good enough for me. The rest of the article is similarly enlightening.

 

[Handy388]

His CD4 count is normal and his viral load is 'undetectable'. I appreciate the people in the thread who seem to have some idea of what HIV is; there's a LOT of misinformation out there. Apparently one school my friend was looking at discouraged HIV+ people from applying because they "wouldn't have a chance to practice long." Maybe they last updated their website in the 1970s 😕.

can someone with a undetectable viral load transmit the disease via blood contact? I think that should be the key of discussion. If he cannot transmit the disease, I think he's fine, but if he can transmit the disease to the patient in anyway, I think it's unwise for him to go into medicine.

 

[inhiding]

😕

This doesn't even make sense.

Good, I'm not going crazy .

Also, I posted this thread in pre-allo only because it's a pre-allo issue. I'm pretty happy that the med students and health care professionals posting seem to be educated about HIV [THANK YOU for your posts] -- I'm just hoping ADCOMs aren't so many generations removed from current HIV advances that they would be concerned about an HIV+ individual's capacity to ultimately perform as a physician.

 

[smq123]

can someone with a undetectable viral load transmit the disease via blood contact? I think that should be the key of discussion. If he cannot transmit the disease, I think he's fine, but if he can transmit the disease to the patient in anyway, I think it's unwise for him to go into medicine.

If you have an undetectable viral load, there's a lower chance that you'll transmit it by blood contact.

HIV is actually surprisingly difficult to transmit in a healthcare setting. Hepatitis C, though, is a whole other story.

 

[VneZonyDostupa]

😕

This doesn't even make sense. If you have a "high" count, then that IS normal. As long as it's over 500 (some people say 450), then it's normal.

I'll admit, this was a mistake I made in posting. I should have put "relatively high". An HIV+ individual may have a "relatively high" CD4 count, but not a normal count, which will put them a a greater, if even slightly greater, risk for infection from other pathogens.

They switch, and THEN they find out that it's a resistant strain?

They don't do resistance testing up in your region of the country? That's odd.

That's not what I said. Please read up on HAART. I said that they may build a resistance to a drug in their current regimen if they skip a few doses, which has been documented time and again. Read up on the "drug holiday" treatment controversy.

And no, resistance testing often is performed in low-cost public health settings. You'll see that when you get out of the academic medical facilities.

And while it's true that HAART is only as effective as the patient taking it, the same is true of insulin. Does this mean that diabetics shouldn't be allowed into medical school?

Did you just compare a sexually transmitted disease to a condition which is not transmissable? Wow.

Remicade is only as effective as the patient taking it, so does that mean that people with Crohn's and psoriasis shouldn't be allowed into med school either?

Can you show me a source where Crohn's is contagious? I really don't think you understand how illogical it is to compare a possibly life-threatening and transmittable disease to diabetes and Crohn's.

That depends on the person and his ID specialist who takes care of him. Assuming that he's not compliant, assuming that his HAART regimen doesn't work, and assuming that his CD4 count is low is unfair to him.

I never said someone should be barred from medical school for being HIV+, so it's a little odd for you to think I'm assuming all of these things about the OPs friend. All I pointed out was that no treatment is 100% against HIV, and your count can drop even when you are on treatment. It happens everyday, even if you personally haven't seen it, promise.

My incredulous tone of voice had nothing to do with my ego.

It had more to do with the fact that your post sounded confident, as if you knew what you were talking about. This made me think that you were in med school.

Which is why I couldn't understand why your post had so much incorrect information in it. That's all.

Well, provide me with some sources that disprove what I've said and I'll take you seriously.

 

[Vihsadas]

can someone with a undetectable viral load transmit the disease via blood contact? I think that should be the key of discussion. If he cannot transmit the disease, I think he's fine, but if he can transmit the disease to the patient in anyway, I think it's unwise for him to go into medicine.

There are rarely any situations where the answer is "No, never." An undetectable viral load means just that: There is not enough viral particles in the blood for the test to measure. Test sensitivity is the big issue here. I know that current techniques can measure down to 5 viral copies per ml of blood. I don't remember the source, but if you pubmed it, you can find it. That being said, some older tests were sensitive to around 10,000 viral particles or greater. So it really depends on the quality of testing equipment that is used to define 'undetectable'.

Now, even though it is theoretically possible to transmit HIV with an undetectable viral load (and yes it should be a concern), I still think that the study posted earlier about looking for doctor -> patient transmissions and the statement from the College of surgeons is extremely solid evidence that the risk of transmission from doctor to patient is negligible if the normal precautions are taken.

 

[193250]

Maybe they last updated their website in the 1970s 😕.

HIV was probably discovered in the 1980's.

 

[chessknt]

There have been some good counterpoints brought up here and while I do not appreciate being hailed as ignorant, I do accept that my understanding of HIV, especially in a physician context, is not complete. I still wonder, however, why no other career path is even a potential option that may be more socially/financially acceptable for someone with his condition?

 

[inhiding]

HIV was probably discovered in the 1980's.

Pardon it was first described in 1981 and 'discovered' in 1983. I don't believe that materially changes my point, however.

And chessknt...well, yeah, he could look for another profession. So could you. <-- Unfortunately, neither of these points is materially relevant to the question I posed.

It's kind of like if the writing sample prompt on the MCAT were "Politicians must often decide to tell the public about their private lives." You cannot write in response: "Politicians should find a new career if they cannot tell the public about their private lives" because you will get a very low score on your writing sample --> it does not answer the question.

 

[chessknt]

Pardon it was first described in 1981 and 'discovered' in 1983. I don't believe that materially changes my point, however.

And chessknt...well, yeah, he could look for another profession. So could you. <-- Unfortunately, neither of these points is materially relevant to the question I posed.

It's kind of like if the writing sample prompt on the MCAT were "Politicians must often decide to tell the public about their private lives." You cannot write in response: "Politicians should find a new career if they cannot tell the public about their private lives" because you will get a very low score on your writing sample --> it does not answer the question.

I wasnt aware that this thread was a writing prompt. I thought it was an open discussion not strictly confined to the original post since we are allowed to see/respond to other people's posts that may or may not be entirely relevant to the original one.

I acknowledged this earlier, but I WOULD consider another pathway. Being a doctor is not the only way to help people and definitely not the sole way to utilize intellect for the betterment of humanity. For example, if he is so passionate about HIV, why doesnt he work on raising public awareness or research a cure for it? You dont have to be a physician to do either of those things and it will allow him to minimize hazards to his health/others. Not saying this is the only choice, but I dont understand why it HAS to be a physician or bust in his special case.

 

[smq123]

An HIV+ individual may have a "relatively high" CD4 count, but not a normal count, which will put them a a greater, if even slightly greater, risk for infection from other pathogens.

But an HIV+ individual may also have a completely normal CD4 count.

Again, in this case that the OP brought up - that will be up to her friend to take care of. If he doesn't want to take care of himself and get his CD4 levels measured regularly, then that's on him. But it's not something that any of us, not even an admissions committee, should decide for him.

I'm not really sure what the point is here. Yeah, an HIV+ individual may have an abnormal CD4 count, or he may have a totally normal CD4 count. Either way - his business, not mine (unless I'm taking care of him).

That's not what I said. Please read up on HAART. I said that they may build a resistance to a drug in their current regimen if they skip a few doses, which has been documented time and again. Read up on the "drug holiday" treatment controversy.

I already had to read about it. Once during 2nd year, and again during the medicine clerkship.

I know that that's true. But again....what does that have to do with the OP's friend? He may skip his doses, or he may be a model patient and take every single one like he's supposed to. It's not for us to judge or say whether he will or not. If he doesn't - he won't develop resistance. If he does (and I hope that he doesn't) - then yeah, he might develop resistance. Either way, it's none of your business nor mine.

And no, resistance testing often is performed in low-cost public health settings. You'll see that when you get out of the academic medical facilities.

😕

Resistance testing IS done in public health settings? Because that's what I thought was the case. I know that a lot of the low-cost public HIV/AIDS facilities in my city will do resistance testing.

Did you just compare a sexually transmitted disease to a condition which is not transmissable? Wow.

Can you show me a source where Crohn's is contagious? I really don't think you understand how illogical it is to compare a possibly life-threatening and transmittable disease to diabetes and Crohn's.

Yeah, I just compared HIV to diabetes and Crohn's. So?

They're all diseases that can drastically shorten your lifespan. They're all diseases that will impact your life dramatically. They're all diseases that require chronic, careful management. They're all diseases that CAN be managed with chronic, careful treatment. And they're all diseases that shouldn't necessarily prevent you from living a full, satisfying life.

In third year, that's how a lot of the attendings talk about HIV to patients anyway. They always compare it to diabetes. I guess it's rubbed off on me. But if it makes you feel better: lamivudine is only as good as the patient who takes it. Does that mean that people with Hep B shouldn't get into med school?

All I pointed out was that no treatment is 100% against HIV, and your count can drop even when you are on treatment. It happens everyday, even if you personally haven't seen it, promise.

Of course nothing's 100%. The OP's friend will always have to be conscientious and careful. And his count might drop (although everyone's fluctuates daily, anyway). But...in the end, do these thing really matter? Should they stop the OP's friend from going to med school if he gets in? I don't think that they should.

Well, provide me with some sources that disprove what I've said and I'll take you seriously.

Your quote in your first post on this thread:

This paragraph is actually false. When you have HIV (not AIDS), your immune system IS compromised to an extent. AIDS is defined as HIV which has suppressed your T-cell count below a critical value. You don't go from healthy to AIDS overnight. Your T-cell count will drop/fluxuate, even with medication. Couple this suppression with the lack of sleep and stress of medical school...

wasn't quite correct. Just because you have HIV does NOT MEAN that your immune system is compromised. At all. You might have HIV and have a totally normal CD4 count.

And everyone's T-cell count fluctuates. Yours does. Mine does. It doesn't mean that the medication isn't working, it just means that your body is getting rid of old cells and putting back new ones. So talking about the effect of stress and lack of sleep on "this suppression" didn't really make a lot of sense.

I still wonder, however, why no other career path is even a potential option that may be more socially/financially acceptable for someone with his condition?

It's what he wants, and this is a free country. <philosophical shrug> What makes 45 year olds want to go to medical school and become physicians? Or people with other serious illnesses? If it's what he wants, and they'll accept him, then that's what he wants to do. And it's not really up to us to decide whether or not that's a good decision on his part or not.

 

[diosa428]

Hmm, not sure I agree. Doctors are the ones who fought against "conversion therapy". The AMA staunchly spoke out against it.

http://209.85.141.104/search?q=cach...a+conversion+therapy&hl=en&ct=clnk&cd=3&gl=us

Anyhow, I think you'd be surprised how many Doctors are well educated and have actually dealt with people from all walks of life.

I think most educated people would argue against conversion therapy, especially physicians, as it doesn't make sense from a scientific viewpoint. That doesn't really have much to do with how adcom members will personally feel about this applicant. Some may be fine with it, but there will definitely be some that won't.

 

[Bartelby]

I will admit that I don't know much about HIV, but with today's treatment options I don't think this person is at much higher risk of contracting a patient's illness than any of us. I also don't buy the whole "he should give the spot to someone with higher life expectancy" argument either, because 1) this person's life expectancy is high anyway and 2) as long as he is a good, competent doctor (which it sounds like he will be) he will serve the public well for as long as he can. If we exclude people from medical school based on their projected practice time, we get into a whole mess of "this person is too old to start" or "this person might branch out to other careers or focus on her/his family" concerns. If someone truly wants to serve society as a physician, it is a shame to keep them out because they might ultimately do so for a few less years.

What I am more worried about (as others have suggested) is patient safety. What if as a primary care provider he sticks himself while suturing a patient and transmits the infection? What if in an emergency situation he is somehow cut or pricked and some blood mixes with the patient's? It may be far fetched, but if transmission through these routes is possible I think it would be a big concern. I don't really know if it is possible for such a transmission to happen, but if I were HIV+ and planning a primary care career that would be the biggest concern hovering over me.

I know this is off topic, but frankly the topic has been answered already (it will probably hurt his chances to disclose his HIV status) and I think a conversation about whether a HIV+ doctor is safe to practice is interesting for all of us who are less informed about the issue.

 

[inhiding]

^ OK, that's fair enough. It has been answered. Sounds like we're going with 100% SDN rate of 'don't mention it on your apps'.

Moving on to the other topics...

 

[scarletgirl777]

never mind.

 

[StPlayrXtreme]

I would advise him not to mention being HIV+ in his application, because committees are human too, and have the potential to reiterate the same points brought up by this forum.

That said, I disagree with posts that talk about how medical school is grueling, and not a way to spend his "remaining years." It could be a very long time before seeing any symptoms at all...with advancements in antiretroviral therapy, I really wouldn't be surprised if he's still doing well 30 years from now.

There definitely need to be precautions, but any blood to blood contact between doctor and patient would be unacceptable by any standard. While I agree, it is probably not a good idea to become a surgeon, I wouldn't mind having an HIV+ surgeon, but I'm probably the exception to the rule. In order to transmit anyhting to his patients he would have to cut himself and bleed into a patients wound or somehow contaminate a sharp (which would be unacceptable for any doctor regardless of HIV status). If safety protocols are strictly followed, I don't see any reason why your friend can't be a doctor.

 

[WaterBird]

Hello,

I just registered to point out that the average life expectancy of someone in the OP's friend's age bracket diagnosed with HIV today has a life expectancy of 69 years:
http://www.aidsmeds.com/articles/hiv_life_exectancy_survival_1667_14989.shtml
(from the Lancet originally, but that is protected).

That life expectancy is the same as African-American males
http://www.efmoody.com/estate/lifeexpectancy.html

I think other people have covered the infectiousness issue, but those of you who are crowing about life expectancy should check your facts.

To the OP: It sounds like your friend had already made his decision before you posted. It's sweet that you're worried about it but I don't know what you were actually looking for - validation of your fears? He can't undo putting it in his ps although that was the consensus here. And I do agree with the above that I don't think adcoms will ask him how he got it. I believe that would be unprofessional. They might ask why they should admit him and not someone with the (marginally) reduced lifespan and immunocompromised status, to which he should be able to effectively make his case, and have data at his finger tips as well (maybe he should even print out the lancet article and others that people have posted).

 

[inhiding]

I'm not sure what I wanted. I guess the answer's obvious enough -- part of me figured SOMEONE would have a dissenting opinion about releasing HIV+ status. I want to understand why my friend would feel the need for honesty.

I guess I also needed some way of thinking about what my friend might face in releasing his status. I mean...just instinctively the idea of 'releasing personal health information' is pretty foreign to me. Especially if it's not going to help him.

Also, I just want to know what I can do to be a good friend. I'm not sure how much he wants to talk about it. I know he does sometimes but presumably not all the time -- that would just get oppressive.

I worry about him a lot more than he knows and unfortunately, I'm not in much of a position to help him (financially or otherwise).

 

[ZonaRidicularis]

z

 

[193250]

Rofl at VneZonyDostupa's post. Touche.

 

[smq123]

I'm not sure what I wanted. I guess the answer's obvious enough -- part of me figured SOMEONE would have a dissenting opinion about releasing HIV+ status. I want to understand why my friend would feel the need for honesty.

I guess I also needed some way of thinking about what my friend might face in releasing his status. I mean...just instinctively the idea of 'releasing personal health information' is pretty foreign to me. Especially if it's not going to help him.

I can understand why he'd want to be open about it.

If it comes out later, when he's a third year, it's almost certainly going to be a MUCH bigger deal than it is now. And I think he wants to be accepted for everything that he is - and not have to lie or hide in order to gain an acceptance.

Also, I just want to know what I can do to be a good friend. I'm not sure how much he wants to talk about it. I know he does sometimes but presumably not all the time -- that would just get oppressive.

I worry about him a lot more than he knows and unfortunately, I'm not in much of a position to help him (financially or otherwise).

I understand what you're feeling. I really do - I used do this to one of my closest friends all the time.

But you're not his mother, and you're not his wife. He's an adult, and he'll make his own decisions. Furthermore, there's no real need to "help" him - financially or otherwise.

It sounds like he was really determined to disclose his HIV status. Once he's made that decision, there isn't much that you need to do, or that you should do. No need to second-guess his decision or anything. Just be supportive. Let him talk about it as much as he wants. Don't mention it constantly, but let him talk about it when he wants to....just make sure that he understands that you're totally okay with whatever he wants to talk about. Don't make him feel like he's being foolhardy or rash about this, but just listen whenever he wants to mention it.

When he has rough moments in the application trail (as all applicants do!), just hold his hand and let him vent. If it doesn't work out, and he doesn't get accepted, just take him out drinking and let him rant and rave for a few hours. Beyond that....it's really his application, and he'll deal with it as he sees fit.

 

[BrainBuff]

Wow...I am just amazed at the poor judgement and lack of insight of a lot of the responses.

1.- It would be discriminatory to reject a student on the basis of a medical illness, whether cancer, HIV or whatever. Period. The rest is just outrageous speculation.

2.- In healthcare, universal precautions are taken constantly to protect patients and healthcare workers. You do not "need" to know the HIV status of anyone, because you must assume that everyone is infected.

3.-There is nothing one can do about possible bias from adcoms, whether on the basis of religious beliefs, etc. ( you are likely not to find out anyway..) Actions taken because of personal biases, could always be disguised under another excuse to reject the applicant.

 

[smgfan]

*

 

[ZagDoc]

I hate to say this, because I wish it weren't true, but medicine is still a conservative field, and I honestly think that the only thing worse than telling an adcom that you have HIV is that you got it through gay sex. I mean, it's better than getting it through drug use (obviously) but there are going to be people on adcoms (older, conservative white men who seem to be on every adcom in the country) who are not going to take that well. Again, the advantage is that if your friend is accepted, it will likely be at a school that will be a better fit for him anyway, but it just seems that he may be closing doors by revealing all this information right now.

A fair number of gay men in my med school class. n=1, but I don't think the stigma is nearly anywhere it was even, say, 10 years ago.

HIV is actually surprisingly difficult to transmit in a healthcare setting. Hepatitis C, though, is a whole other story.

Or especially Hep B. What is it? 1/20 blood-to-blood transmission? It's amazing the stigma that a viral infection can incur just because its socially tied to sexual promiscuity or homosexuality.

 

[riceman04]

While it may not be his fault, applying to medical school with HIV seems kind of negligent on his own part--he has to be trained for 7+ years in an environment full of diseases and also carries the unique attribute of being a risk to his patients. The potential for his immune system to collapse and die is enormous in this situation and would ultimately mean that he took a seat that somebody else who does not face these challenges could have taken. I know med schools arent supposed to discriminate based on health status and whatnot, but sometimes certain career paths become inaccessible because of our life situations. Why not go for a PhD with medical applications?

I mean seriously! Many of your assumptions must result from you being misinformed

 

[riceman04]

Chances are he'll get some interviews.
Chances are he's going to have to face some difficult questions from the committee during those interviews.
Chances are that his risk for contracting an illness during rotations are going to increase.
Chances are he will not be able to do a residency like surgery which can put his patients at risk.
Chances are that he's going to face a lot of hardships going this route.
Chances are he will always regret not trying if he didn't.

Sounds like your friend really wants to do this. He's not stupid, I'm sure he's well aware (more than any of us) of what he's capable of and what his limitations are. He can very well get his medical education and do something wonderful with it such as research or academia. His disclosure at this point in the game speaks volumes.

For those of you criticizing this young man on going after his interests, consider the fact that you may be working alongside a colleague who is HIV+ or has hepatitis and you don't even know it because they chose not to disclose this information.

ahahahahahah...I like your screename...good play off zona reticularis...yes yes...all that is very ridiculous

 

[riceman04]

Someone above mentioned a biobag. As a citizen, it's disturbing to read these type of comments from a future physician.

To the OP, although it's a bold topic to discuss in secondary applications, it's ultimately his decision and as a friend all you can do is continue to support his decision to pursue his passion/interests. All the best to you both.

keep in mind that most of these pre-meds would be hard pressed to keep their word holes closed (in person) even if a topic was presented on which they knew nothing about. It is almost like that is the pre-med condition - to appear as if you know it all when you really dont know a damn thing!