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Ideas and Opinions |15 September 1996

Prophylaxis for Occupational Exposure to HIV

Julie Louise Gerberding, MD, MPH

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Copyright ©2004 by the American College of Physicians
  • From San Francisco General Hospital, San Francisco, California. For the current author address, see end of text. Note: Dr. Gerberding was a corporate consultant for Kimberly Clarke and 3M Corporation and was supported by Glaxo-Wellcome, Pfizer, and Bayer while preparing this paper. Requests for Reprints: Julie Louise Gerberding, MD, MPH, Epidemiology and Prevention Interventions Center, Medical Service 5H22, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110.
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Health care providers who are parenterally exposed to human immunodeficiency virus (HIV) are at risk for infection. The average risk attributed to needle punctures and similar percutaneous injuries involving HIV is approximately 0.32% (95% CI, 0.18% to 0.46%), or 21 infections after 6498 exposures [1-3]. This risk estimate, which is based on data taken from 25 prospective studies of occupational exposure, does not account for factors that may change the probability of transmission during a specific exposure. The virus inoculum (the volume of material involved in an exposure and the titer of infectious virus in that material) is one important determinant of risk. New data suggest that antiretroviral treatment after exposure may also be an important factor affecting the outcome of occupational exposure to HIV.
In a case–control study, the Centers for Disease Control and Prevention (CDC) found that five factors were independently associated with the risk for HIV infection after percutaneous injury (Table 1) [4]. Three of these factors (deep injuries, visible blood on the device before injury, and devices that were used in an artery or vein before injury are probably markers for exposure to a greater volume of infected blood. Exposure to blood from a source patient with preterminal acquired immunodeficiency syndrome [AIDS] was also associated with an increased risk for infection (patients were considered preterminal if they died within 2 months of the exposure). High virus titers, which are typically present in advanced HIV disease, and possibly phenotypic or genotypic differences among...
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Gerberding JL. Prophylaxis for Occupational Exposure to HIV. Ann Intern Med. 1996;125:497–501. doi: 10.7326/0003-4819-125-6-199609150-00011

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Published: Ann Intern Med. 1996;125(6):497-501.

DOI: 10.7326/0003-4819-125-6-199609150-00011

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