It is accepted now with little fanfare how safer needle devices, post-exposure prophylaxis, and other improvements and interventions have reduced occupational HIV infection to a vanishing point. This wasn’t always the case.

June 5, 2018, will mark 37 years since the CDC reported five cases of Pneumocystis carinii pneumonia in gay men in Los Angeles.1

The occupational infections that occurred at that time through needlesticks and blood exposures are exceedingly rare today, but some risk remains.

It is well to remember that HIV was once a uniformly fatal condition. While highly effective viral suppression treatments are available now, at that time HIV was seen as a virtual death sentence.

Occupational HIV remains a threat to healthcare workers because new sexually transmitted infections keep occurring in the community.

“We have close to 40,000 new HIV infections every year. HIV is often a fatal disease if it is not treated, and it continues to be a challenge to reduce the number of new infections every year,” said Jonathan Mermin, MD, MPH, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, at a recent CDC press conference.

However, there are also encouraging signs, and more gains will be seen if routine HIV testing becomes the norm, he stressed.2

“We’ve seen reductions in HIV incidence — the number of new infections — every year in the country over the past decade,” Mermin said. “And we’ve seen dramatic reductions in mortality among people with HIV due to very effective medicine that can now be taken once a day in most cases.”

Overall, 58 cases of confirmed occupational transmission — and 150 possible cases — of HIV to healthcare workers have occurred in the U.S. Of these, only one confirmed case has been reported since 1999, the CDC notes. However, there may be some underreporting of occupational HIV, as case reporting is voluntary.

“Healthcare workers who are exposed to a needlestick involving HIV-infected blood at work have a 0.23% risk of becoming infected,” the CDC notes.3 “In other words, 2.3 of every 1,000 such injuries, if untreated, will result in infection. Risk of exposure due to splashes with body fluids is thought to be near zero even if the fluids are overtly bloody. Fluid splashes to intact skin or mucous membranes are considered to be extremely low risk of HIV transmission, whether or not blood is involved.”

REFERENCES

1. CDC. Pneumocystis pneumonia — Los Angeles. MMWR 1981;30:250–252.

2. CDC. HIV Testing. Vital Signs Nov. 28, 2017. Available at: http://bit.ly/2zNEolj.

3. CDC. Occupational HIV Transmission and Prevention among Health Care Workers. Available at: http://bit.ly/2Ecq0SC.