Dental and research transmission of acquired immune deficiency syndrome? Or, is there any evidence that human immunodeficiency virus is sufficient to cause acquired immune deficiency syndrome?

Abstract

An unpublished report of three laboratory workers exposed to concentrated human immunodeficiency virus cultures and one anomalous case of putative dental transmission to six patients represent the only evidence of acquired immune deficiency syndrome developing in the absence of immunologic cofactors such as exposure to sexually transmitted diseases, drugs, malnutrition, and alloantigens. A review of the Centers for Disease Control (USA) files shows that all six dental patients had identified risks for human immunodeficiency virus infection other than dental treatment, and evidence of cofactor exposures. Several demonstrated immunologic abnormalities prior to dental treatment. These data were ignored by the Centers for Disease Control. Furthermore, known rates of human immunodeficiency virus transmission by blood clotting factor use (1 infection per 20 exposures) and percutaneous exposure (1 per 250) make the number of patients the dentist would have had to expose to get six infections unrealistic (circa 120–1500). Thus, no clear-cut evidence exists for human immunodeficiency virus infection in the absence of predisposing immunologic cofactors.