In the 1980s, when HIV infection was tantamount to a death sentence, healthcare workers bravely took care of the first epidemic waves of AIDS patients.

Tragically, needlesticks and blood exposures then led to the first occupational HIV infections, propelling the movement for sharps safety in healthcare.

Now, such infections are very rare, though 12 other healthcare workers contracted HIV infections possibly through their occupations, the CDC reports.1

The improvement in HIV treatment often means lower viral loads for patients and better post-exposure prophylaxis for healthcare workers, says David Kuhar, MD, medical officer with CDC’s division of healthcare quality promotion. But healthcare workers must report exposures and receive prompt evaluation and follow up, he says.

REPORTING NEEDLESTICKS, EXPOSURES STILL CRITICAL

“It remains critical to report these injuries and take them seriously, and not just [out of concern] for HIV,” he says. “There’s also risk for infection with other bloodborne pathogens.”

The only recent confirmed case of occupationally acquired HIV involved a technician in a research laboratory who sustained a needlestick with an HIV-positive culture in 2008.

For some reason, the technician did not take antiviral medications for post-exposure prophylaxis, says M. Patricia Joyce, MD, medical officer and epidemiologist with CDC’s division of HIV/AIDS prevention.

“We don’t know all the factors and decisions that were made in the clinical management of this case,” she says, adding that testing, evaluation, and follow up must be conducted in a timely manner.

Between 1985 and 2000, 57 healthcare workers had documented cases of occupationally acquired HIV.

Twenty-four (42%) of them were nurses and 16 (28%) were laboratory technicians. Some 88% of the incidents involved hollow-bore needles.2

FIVE SUSPECT CASES IN CLINICAL LAB TECHS

Of the 12 cases since 2003 that were deemed to have a possible occupational link, five were clinical lab technicians, two were nurses, and one was a non-surgical physician, Joyce says.

“Nurses are among the highest risk [groups] both for the confirmed and the possible [cases],” she says.

Joyce also notes that hospice nurses and health aides have potential exposure to blood and body fluids and also are at risk of HIV and other bloodborne pathogens.

The small number of occupationally acquired HIV cases shows the effectiveness of precautions, safer devices, and prophylaxis. But that shouldn’t be interpreted as evidence that there’s less risk of contracted HIV from a needlestick or other exposure, say Joyce and Kuhar.

“We don’t know how many people were at risk and because they followed [recommended protocols] and took post-exposure prophylaxis didn’t get infected,” says Joyce.

REFERENCES

  1. Joyce MP, et al. Notes from the field: Occupationally acquired HIV infection among health care workers — United States, 1985–2013. MMWR Morb Mortal Wkly Rep 2015;63:
    1245-1246.
  2. Do AN, et al. Occupationally acquired HIV infection: National case surveillance data during 20 years of the HIV epidemic in the United States. Infect Control Hosp Epidemiol 2003;24:86-96.