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Lack of HIV Transmission in the Practice of a Dentist with AIDS

Harold W. Jaffe, MD; Joyce M. McCurdy, MSA; Marcia L. Kalish, PhD; Thomas Liberti, BS; Georges Metellus, MD, MMH; Barbara H. Bowman, PhD; Sonia B. Richards, MD; Annie R. Neasman, RN, MS; and John J. Witte, MD, MPH
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From the Centers for Disease Control and Prevention, Atlanta, Georgia. The Florida Department of Health and Rehabilitative Services, Tallahassee, Florida, and Miami, Florida. Roche Molecular Systems, Alameda, California. Requests for Reprints: Harold W. Jaffe, MD, Division of HIV/AIDS (G29), Centers for Disease Control and Prevention, Atlanta, GA 30333. Acknowledgments: The authors thank Stacy Bourgeois, Mercedes Escalante, Carol Trotter, Charlene Gilbert, Charlotte Gloster, and Tom Walch for epidemiologic assistance; Claudiu Bandea, Chi-Ching Luo, Nick De la Torre, and Jennifer Rapier for laboratory assistance; and Robert Dumbaugh, Alan Lasch, and Donald Marianos for reviewing the dental aspects of the investigation.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(11):855-859. doi:10.7326/0003-4819-121-11-199412010-00005
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Objective: To determine whether dentist-to-patient or patient-to-patient transmission of human immunodeficiency virus (HIV) occurred in the practice of a dentist who had the acquired immunodeficiency syndrome (AIDS).

Design: Retrospective epidemiologic investigation supported by molecular virology studies.

Setting: The practice of a dentist with AIDS in an area with a high AIDS prevalence.

Participants: A dentist with AIDS, his former employees, and his former patients, including 28 patients with HIV infection.

Measurements: Identification of potential risks for acquisition of HIV infection, genetic relatedness among HIV strains, and infection-control practices.

Results: A dentist with known behavioral risks for HIV infection, who was practicing in an area of Miami, Florida, that had a high rate of reported AIDS cases, disclosed that he frequently did invasive procedures and did not always follow recommended infection-control procedures. Of 6474 patients who had records of receiving care from the dentist during his last 5 years of practice, 1279 (19.8%) were known to have been tested for HIV infection and 24 of those (1.9%) were seropositive. Four other patients with HIV infection were identified through additional case-finding activities. Of these 28 patients with HIV infection, all but 4 had potential behavioral risk factors for infection. Phylogenetic tree analysis of HIV genetic sequences from the dentist and 24 of the patients with HIV infection showed an absence of strong bootstrap support for any grouping and therefore did not indicate that the virus strains were linked.

Conclusions: Despite identifying numerous patients with HIV infection, we found no evidence of dentist-to-patient or patient-to-patient transmission of HIV during dental care. Our findings are consistent with those of all previous studies in this area, with the exception of one that did identify such transmission.


Grahic Jump Location
Figure 1.
Unrooted phylogenetic tree illustrating the relations among HIV sequences obtained from the dentist, 24 of his former dental patients, and 2 sexual partners of patients.

Genetic distance bootstrap results support only one pairing of sequences, that of O and O-1, so the other branches are shown as a “star phylogeny.” Branch lengths are arbitrary.

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