Zeroing in on the Appropriate Management of Occupational Exposures to HIV-1

Abstract

Transmission of human immunodeficiency virus type 1 (HIV-1) in the healthcare setting continues to be a concern for the healthcare community. Although in the tenth year of the HIV epidemic in the United States we have learned a great deal about some aspects of the occupational risks associated with the provision of care for HIV-l-infected individuals, we still lack several important pieces of information regarding these risks. While several prospective clinical studies have provided information regarding the magnitude of risk for HIV-1 infection associated with percutaneois or mucous membrane exposures to body fluids containing HIV-1,1 we have yet to gain much insight into factors associated with occupational injuries that influence risks for infection. For example, most of the instances of documented occupational/nosocomial transmission of HIV-1 described in the literature have resulted from inadvertent occupational exposures to what might be called hot needles (i.e., healthcare worker infections resulting from parenteral exposures to needles [or other sharp objects] that had been removed from HIV-l-infected patients or from specimens containing blood from such patients only moments prior to the exposure).1 Such exposures are also likely to produce the most obvious concern among healthcare providers and are, therefore, perhaps the most likely to be reported and carefully documented. Thus, the precise role of the immediacy of the exposure in producing occupational infection remains unclear.