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AN UPDATE ON OCCUPATIONAL HIV EXPOSURE.

The U.S. Centers for Disease Control and the Italian Ministry of Health have been monitoring worker exposures to HIV-infected blood at selected hospitals. These reports provide data on seroconversion rates and patterns of postexposure zidovudine prophylaxis.

In the American study, 1245 exposed workers underwent HIV antibody testing within 1 month and at least 180 days after the exposure. Eighty-nine percent of exposures were percutaneous (e.g., via needlestick) and 11 percent involved contact with mucous membranes or non-intact skin. Four workers (0.36 percent) seroconverted, all with percutaneous exposure. The Italian study yielded similar findings: seroconversion rates were 1 in 1003 (0.10 percent) after a percutaneous exposure, and 1 in 158 (0.63 percent) after mucous-membrane contact; neither worker took postexposure zidovudine.

Beginning in 1988, 31 percent of workers in the American study took postexposure zidovudine. Of 444 percutaneously exposed workers who were followed for at least 180 days, 143 took zidovudine and 301 did not. Only 1 seroconverted; this worker began zidovudine within 12 hours of exposure. Nearly a third of zidovudine users did not complete treatment because of side effects.

Comment: These reports are reassuring because they confirm previous estimates of low seroconversion rates after occupational exposure to HIV. However, the efficacy of postexposure zidovudine prophylaxis remains unclear. There are now at least eight reported cases of HIV seroconversion in patients who started zidovudine less than 12 hours after percutaneous exposure.

— ASB

Published in Journal Watch General Medicine July 9, 1993

Citation(s):

Ippolito G et al. The risk of occupational human immunodeficiency virus infection in health care workers: Italian Multicenter Study. Arch Intern Med 1993 Jun 28 153 1451-1458.

• Medline abstract (Free)

Tokars JI et al. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV- infected blood. Ann Intern Med 1993 Jun 15 118 913-919.

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• Medline abstract (Free)