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Only 1 HIV Infection Due to Occupational Exposure Since 1999

A total of 58 confirmed and 150 possible cases of occupationally acquired HIV infection among healthcare workers were reported to the Centers for Disease Control and Prevention (CDC) between 1985 and 2013, but only a single confirmed case has occurred since 1999, according to a report in the January 9 Morbidity and Mortality Weekly Report. Investigators attributed the recent lack of infections to improved precautions and antiretroviral post-exposure prophylaxis (PEP). 

Healthcare workers are at risk for HIV infection due to needle-sticks and other accidents that allow exposure to blood or other body fluids containing the virus. Standard precautions such as wearing gloves and goggles can reduce the risk. People who are exposed can start combination antiretroviral therapy (ART) within 72 hours to prevent the virus from establishing itself in the body, a protocol that has been recommended since 1996.

M Patricia Joyce, David Kuhar, and John Brookes from the CDC did an analysis of cases of occupational HIV infection among healthcare workers since the early years of the epidemic. Investigation of such cases are conducted by state health departments with assistance from the CDC, and since 1991 reports of occupational infections have been recorded by the National HIV Surveillance System. A confirmed case requires documentation that a healthcare worker seroconverted after a specific exposure to a known HIV positive source.

Results

• During 1985-2013 there were 58 confirmed and 150 possible cases of occupationally acquired HIV infection among healthcare workers reported to the CDC.
• Among these cases, the routes of exposure were percutaneous punctures or cuts (49 cases), mucocutaneous exposures (5 cases), both percutaneous and mucocutaneous exposures (2 cases), and unknown exposures (2 cases).
• 49 of these healthcare workers were exposed to HIV-infected blood, 4 to concentrated virus in a laboratory, 1 to visibly bloody fluid, and 4 to unspecified body fluids.
• Since 1999, however, only 1 confirmed occupational infection has occurred, involving a lab technician who sustained a needle puncture while working with a live HIV culture in 2008.

"Documented occupational acquisition of HIV infection in healthcare workers has become rare in the United States," the report authors concluded. "Whereas the paucity of cases could be the result of underreporting, it might indicate the effectiveness of more widespread and earlier treatment to reduce patient viral loads, combined with prevention strategies such as postexposure management and prophylaxis as well as improved technologies and training to reduce sharps injuries and other exposures."

"The CDC recommends the use of standard precautions to prevent exposure of healthcare workers to potentially infectious body fluids when working with any patient, whether known to be infected with HIV or not," the authors wrote. "Healthcare workers should assume that body fluids from all patients are infectious even if the patients are not known to be infected with HIV."

"Although preventing exposures to blood and body fluids is the most important strategy for preventing occupationally acquired HIV, when occupational exposures do occur, appropriate post-exposure management is critical," they continued.

1/29/15

Reference

MP Joyce, D Kuhar, JT Brookes. Notes from the Field: Occupationally Acquired HIV Infection Among Health Care Workers -- United States, 1985-2013. Morbidity and Mortality Weekly Report63(53):1245-1246. January 9, 2015.