Sir, the DOH guidance entitled 'HIV Infected Health Care Workers' says that HIV infected health care workers should avoid exposure prone procedures which for a dentist effectively means restricting practice to full dentures and teaching. I know of several dentists who became HIV positive and had to give up practice but having read an article in the 21/2/09 edition of the New Scientist I wonder if the time has come to change the guidance. The author (Clare Wilson the medical features editor) explains how the progress of HIV is gauged by measuring the level of CD4 cells - immune cells the virus infects and kills. In the past treatment with antiretroviral drugs only commenced when the CD4 level fell below 200 (it is 500 or more in a healthy person) but now people who once had to take 20 tablets a day are down to one or two a day with fewer side effects and it appears there are health benefits from taking the drugs at an earlier stage when the CD4 level is higher.

The article states that people who are scrupulous in taking their tablets may have no virus detectable in their blood and that 'doctors now see patients with normal CD4 counts asking to start therapy purely to avoid passing on the virus.'

So, if an HIV positive dentist adopted an appropriate regime of antiretroviral drugs such that s/he no longer had any detectable virus in their blood would this mean they could not infect patients and therefore be able to treat them? If so then is it time to change the rules?