Reports on HIV/AIDS: 1990

JULY 27, 1990, MMWR, Vol. 39, No. 29, pp. 489-493
Prospective investigations of HIV transmission from patients to health-care workers indicate that the risk for HIV transmission after percutaneous exposure to
HIV-infected blood averages 0.4% (7). Four investigations have been reported that
attempted to assess the risk of HIV transmission from infected health-care workers to
their patients (8-11). In the largest study, 616 patients who underwent surgery by a
general surgeon during the 7 years preceding his diagnosis of AIDS were tested for
HIV antibody. One patient, an IV-drug user, was positive for HIV antibody (8). Viral
strains from the patient and the surgeon were not characterized.
Transmission of hepatitis B virus (HBV), which has epidemiologic transmission
patterns similar to HIV, from health-care workers to patients during invasive medical
(primarily gynecologic surgery) and dental (primarily oral surgery) procedures has
been reported (12-15). The dental procedures in which HBV was transmitted
involved oral surgical procedures such as dental extractions. In these reported
instances, the dental workers did not routinely wear gloves and were thought to have
sustained puncture wounds or had skin lesions or microlacerations that allowed virus
to contaminate instruments or open wounds of patients. Also, these health-care
workers (when tested) have been positive for hepatitis B e antigen, a marker that
indicates very high titers of virus in blood and correlates with increased transmissibility of HBV.
Restrictions on patient care for health-care workers with HIV infection have been
considered by the American Medical Association (16), the American Hospital Association (17), the American Dental Association (18), the American College of Obstetricians and Gynecologists (19), the British government (20), CDC (21), and other
organizations. Although the specific recommendations of these organizations vary to
some extent, these recommendations generally have stated that the risk, if any, of HIV
transmission from health-care workers to patients occurs during invasive procedures
and that decisions regarding restrictions of patient care by infected workers who
perform such procedures should be made on an individual basis.
The epidemiologic and laboratory findings in this investigation indicate possible
transmission of HIV from the dentist to the patient. Regardless of the interpretation of
the findings in this investigation, adherence to universal precautions, including
prevention of blood contact between health-care workers and patients and proper
sterilization and disinfection of patient-care equipment, is important for prevention of
transmission of bloodborne pathogens in health-care settings (21-23). CDC is
considering the implications of this case in its review of the guidelines for prevention
of transmission of HIV and other bloodborne pathogens to patients during invasive
procedures.
References
1. Ou CY, Kwok S, Mitchell SW, et al. DNA amplification for direct detection of HIV-1 in DNA of
peripheral blood mononuclear cells. Science 1988;239:295-7.
2. Burger H, Belman A, Grimson R, et al. Long HIV-1 incubation periods and dynamics of
transmission within a family. Lancet 1990;336:134-6.
3. Myers G, Rabson AB, Josephs SE, Smith TF, Berzofsky JA, Wong-Staal F. Human retroviruses and AIDS, 1989. Los Alamos, New Mexico: Los Alamos National Laboratory, Theoretical Division, 1989.
4. Cooper DA, Gold J, MacLean P, et al. Acute AIDS retrovirus infection: definition of a clinical
illness associated with seroconversion. Lancet 1985;1:537-40.
5. Lifson AR, Hessol N, Rutherford G, et al. Natural history of HIV infection in a cohort of
homosexual and bisexual men: clinical and immunologic outcome, 1977-1990 [Abstract].
Vol 1,. VI International Conference on AIDS. San Francisco, June 20-24, 1990:142.

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