Ridzon R, Gallagher K, Ciesielski C, et al. Simultaneous transmission of human immunodeficiency virus and hepatitis C virus from a eedle-stick injury. N Engl J Med 1997; 336:919-922.
Authors from the federal Centers for Disease Control and Prevention and the Neponset Valley Health System in Norwood, MA, document an infection with both HIV and HCV that a 48-year-old female health care worker acquired simultaneously from a single source.
HIV seroconversion was detected between eight and nine and a half months post-exposure, and HCV seroconversion occurred between nine and a half and 13 months post-exposure. The worker died 28 months post-exposure.
"These times to seroconversion are unusually long for both viruses," the authors note. "The clinical course of the health care worker was remarkable for rapid progression to hepatic failure and death."
The HCW had sustained a deep injury with a blood-contaminated needle in July 1990 while performing phlebotomy on an AIDS patient. Blood also spilled from the collection tube into the spaces between the HCW’s glove cuffs and her wrists and onto her hands, which were chapped with open cracks. The worker removed the gloves and washed her hands immediately after the incident.
The patient had been diagnosed with HIV in 1987 and was receiving zidovudine therapy, but was not recognized as having HCV infection. The HCW declined zidovudine prophylaxis. She reported no behavioral or transfusion-related risk factors for HIV infection. Baseline testing for anti-HCV was not done because the source patient was not initially identified as HCV-infected.
Eight months post-exposure the HCW reported low-grade fever, chills, myalgia, nausea, vomiting, diarrhea, sweating, headache, and appetite loss. The paper summarizes her clinical course and corresponding laboratory test results at eight, 10, 21, 24, and 28 months postexposure, at which time hepatic coma and progressive renal failure developed, and the worker died. Postmortem examination revealed micronodular cirrhosis of the liver without evidence of opportunistic infection or cancer.
In noting the unusually long incubation periods for both HIV and HCV in the worker, the authors state that perhaps current, more sensitive tests for both antibodies could have detected seroconversion earlier.
"The reasons for the unusual clinical and laboratory features of this health care worker’s illness are unclear," they say. Immune dysfunction with delayed antibody response is unlikely because the worker was previously healthy, had no history of recurrent infection, and the results of serum protein electrophoresis were normal.
The course may have been related to simultaneous acquisition of the two infections, they surmise, offering evidence of pathogenic interaction between the two viruses.
While the Public Health Service does not recommend routine HIV serologic follow-up beyond six months post-exposure, "[i]n the case of simultaneous occupational exposure to HIV and HCV or in the event of clinical symptoms or signs of infection more than six months after exposure, evaluation for late seroconversion may be needed. The possible pathogenetic interactions between HIV and HCV warrant further study," the authors conclude.