Standards, Equality and Safety in Mohs Micrographic Surgery for patients living with HIV.

Alani, A; Allstaff, S; Yirell, D; Topping, D; Affleck, A

Dear Editor, the number of people living with diagnosed HIV (PLWHIV) is growing older and diversifying. In 2017, 98% of people receiving HIV care in the UK were on antiretroviral treatment and of those, 97% had an undetectable viral load (uVL). There is consensus that HIV with an uVL is not infectious. A minority of PLWHIV have a detectable viral load, however, almost always, HIV tends to be transmitted by undiagnosed individuals. An accepted custom has been for histopathology samples from PLWHIV to be processed differently from those without known HIV infection to mitigate the risk of transmission to clinical and laboratory staff. Recent personal communication with 25 different Mohs centres in the UK highlighted a diverse range of practice; 44% performed conventional frozen-section Mohs surgery on PLWHIV with an uVL, with the remainder using "slow Mohs" surgery with formalin-fixed sections for all PLWHIV regardless of viral load status. Our findings of practice in this regard, are similar to those reported in the USA.