Risk for Occupational Transmission of Human Immunodeficiency Virus Type 1 (HIV-1) Associated with Clinical Exposures

A Prospective Evaluation

  1. David K. Henderson, MD;
  2. Barbara J. Fahey, BSN;
  3. Mary Willy, BSN, MPH;
  4. James M. Schmitt, MD, MS;
  5. Kathleen Carey, RN, MS;
  6. Deloris E. Koziol, PhD;
  7. H. Clifford Lane, MD;
  8. Joan Fedio, RN; and
  9. Alfred J. Saah, MD, MPH

    Abstract

    Objectives: To summarize the results of a 6-year, ongoing, prospective study of the risk for human immunodeficiency virus type 1 (HIV-1) transmission among health care workers, and to estimate the magnitude of the risk for HIV-1 infection associated with different types of occupational exposures.

    Design: Prospective cohort study; the median follow-up for employees sustaining parenteral exposures was 30.2 months (range, 6 to 69 months).

    Subjects: Health care workers at the Clinical Center, National Institutes of Health, including those reporting parenteral and nonparenteral occupational exposures to HIV-1.

    Measurements and Main Results: One thousand three hundred and forty-four clinical health care workers reported 179 percutaneous and 346 mucous membrane exposures to fluids from HIV-1-infected patients during a 6-year period. Responding to a supplementary questionnaire, 559 of these workers reported 2712 cutaneous exposures to blood from HIV-1-infected patients and more than 10 000 cutaneous exposures to blood from all patients during a 12-month period. Occupational transmission of HIV-1 occurred in a single worker after a parenteral exposure to blood from an HIV-1-infected patient. No infections occurred after either mucous membrane or cutaneous exposures to blood from HIV-1-infected patients. Use of newer diagnostic technologies (for example, antigen detection, gene amplification) has not resulted in the identification of occupationally transmitted seronegative infections.

    Conclusions: Combining our results with those of other prospective studies, the risk for HIV-1 transmission associated with a percutaneous exposure to blood from an HIV-1-infected patient is approximately 0.3% per exposure (95% CI, 0.13% to 0.70%); the risks associated with occupational mucous membrane and cutaneous exposures are likely to be substantially smaller. These data support the use of barrier precautions and suggest a need for strategies that change health care providers' attitudes and behaviors.

    Article and Author Information

    • From the Clinical Center and the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; and the Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland. For current author addresses, see end of text.

    • Requests for Reprints: David K. Henderson, MD, Building 10, Room 2C146, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892.

    • Current Author Addresses: Drs. Henderson and Koziol, Ms. Fahey, and Ms. Willy: Building 10, Room 2C146, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892.

      Dr. Schmitt, Ms. Carey, and Ms. Fedio: Building 10, Room 6C306, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892.

      Dr. Lane: Building 10, Room 11B09, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892.

      Dr. Saah: Johns Hopkins University School of Public Health and Hygiene, 550 North Broadway, Suite 701, Baltimore, MD 21205.

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    1. Ann Intern Med November 15, 1990 vol. 113 no. 10 740-746
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