Human immunodeficiency virus disclosure and patient confidentiality in orthopaedic procedures

A thirty-two-year-old man with hemophilia whose chief complaint was knee pain was referred by his hematologist for consideration of a total knee arthroplasty. On his initial visit, the patient was seen and evaluated with his pregnant wife and their infant child present in the examination room at his request. During the review of systems and past medical history, the treating surgeon inquired into the status of his human immunodeficiency virus (HIV) viral load and CD4 count. At that point, the patient denied ever testing positive for HIV. Later, in a private discussion, the patient confirmed his HIV-positive status. He admitted that his wife was unaware of his history, and he stated that he did not wish her to know. The surgeon explained to the patient that his HIV history posed a major health risk to his wife and children and encouraged him to discuss it with her. The surgeon sought the advice of the institution's legal counsel. It was explained that, according to state law, the surgeon was not obliged to, but could, inform the patient's wife of the situation. At the next visit, the surgeon again asked the patient to discuss the situation with his spouse. The patient agreed to do so. To confirm that the information had been conveyed, the surgeon asked the patient to return with his wife to discuss the patient's HIV status and the informed consent pertinent to total knee arthroplasty. When the patient did not return, the surgeon notified the referring hematologist of the situation.