Provider-to-Patient HIV Transmission: How To Keep It Exceedingly Rare

• Infection control
• Human immunodeficiency virus infections
• Disease transmission, professional-to-patient
• Orthopedic procedures
• Bloodborne pathogens

In 1990, epidemiologic data and DNA sequence analyses linked a Florida dentist with AIDS to HIV infection in 6 of his patients (1, 2). Since then, at least 22 759 patients who received medical care from 53 U.S. health care providers with HIV infection (including 29 dental care workers and 15 surgeons and obstetricians) have been evaluated in retrospective studies monitored by the Centers for Disease Control and Prevention (3). Of the 113 patients who were found to have HIV infection, 28 received the diagnosis before they had contact with the infected health care provider, 77 had other defined risks for HIV infection, and 3 are still under investigation. The remaining 5 infected patients did not acknowledge risks associated with HIV infection. Virus isolates from 3 of the 5 pairs of patient and health care provider were not related according to DNA sequence analysis.

Despite the enormous effort and expense required to accomplish these retrospective “look-back” studies, no new cases of nosocomial HIV transmission were detected. In addition, investigations of HIV-infected persons with no identified risk reported to the national HIV/AIDS surveillance system have failed to identify additional cases of provider-to-patient HIV transmission in the United States since the dental cases were identified (4). In 1998, the data substantiate what was only suspected in 1990—an infected provider can transmit HIV to a patient during …