Serologic Tests For Human Immunodeficiency Virus Research Articles

Abstract 120: A closer Look at colorectal cancer risk: Insights from the complex relationship of HIV, helminths, and immune responses

Abstract The advent of antiretroviral therapy has markedly increased the survival rates of individuals with human immunodeficiency virus (HIV). However, this demographic, particularly in low-middle-income countries (LMICs) where HIV-helminth co-infections are prevalent, remains susceptible to infections. The intricate interplay between helminth infections and HIV susceptibility, often inducing immunological phenotypes that heighten vulnerability, remains poorly understood. Studies have shown the association between HIV-helminth co-infections and elevated susceptibility to colorectal cancer (CRC), introducing an additional layer of health concerns for this already vulnerable population. This retrospective observational study delves into the profound effects of HIV-helminth co-infections on immune responses, with a specific focus on type 2 T helper (Th2) cell immunomodulation and susceptibility to CRC. Utilizing samples from a master project (n=414), 80 systematically randomized individuals were categorized into uninfected control, HIV-infected only, helminth-infected only, and HIV-helminth co-infected groups. Parasite detection employed the Kato-Katz technique, and serum testing was conducted for helminth-specific antibodies. Serological HIV testing, viral load categorization, white blood cell counts, and differential analyses were performed. Human ProcartaPlex Panel 1 was used for cytokine profiling of immune stimulatory and inhibitory soluble proteins. A significant reduction in B and T lymphocyte attenuator (BTLA) (p=0.049) in helminth infections compared to the control. The association of BTLA with its ligand, herpesvirus entry mediator (HVEM), establishes a direct link between the CD28 and tumor necrosis factor receptor (TNFR) families, triggering wide-ranging and robust immune responses. Subsequently, a notable reduction in CD28 was observed in HIV-infected subjects (p=0.003), followed by helminth-infected and HIV-helminth co-infected individuals (p=0.03) compared to the control. Furthermore, programmed death ligand-2 (PD-L2) expression, a major contributor to alternatively activated macrophage polarization during helminth infections, was significantly increased in the HIV-helminth co-infected group (p = 0.05), favoring a shift towards Th2 immune responses. These observed alterations underscore the complexity of the immunological interplay in co-infected individuals, emphasizing an additional risk factor for colorectal cancer development. This necessitates a comprehensive understanding, providing valuable insights for the development of therapeutic strategies in LMICs and similar settings, addressing the heightened risk of CRC within this population. Citation Format: Botle P. Damane, Thanyani V. Mulaudzi, Sayed S. Kader, Ropo E. Ogunsakin, Pragalathan Naidoo, Zodwa Dlamini, Zilungile L. Mkhize-Kwitshana. A closer Look at colorectal cancer risk: Insights from the complex relationship of HIV, helminths, and immune responses [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 120.

Cerebral Venous Thrombosis as The Sole Presenting Manifestation of Human Immunodeficiency Virus and Hepatitis B Virus Co-Infection.

Cerebral venous thrombosis (CVT) following either human immunodeficiency virus (HIV) infection or hepatitis B virus (HBV) infection is a very rare condition. Moreover, it has never been reported as the presenting manifestation of HIV and HBV co-infection, even more so when the patient had a normal CD4 count and no demonstrable opportunistic infections. We aimed to report the first case of an adult Indian male, an intravenous drug abuser who developed CVT as the presenting manifestation of HIV-HBV co-infection. Patient data were obtained from medical records from the Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India. A 25-year-old male with a history of intravenous drug abuse and a normal CD4 count developed CVT as the presenting manifestation of HIV-HBV co-infection. His CD4 count was normal, and he had no demonstrable opportunistic infections. He had an uneventful recovery of the condition (CVT) following the institution of conventional anticoagulation therapy alongside anti-retroviral therapy. Whether illicit drug abuse or HIV/HBV infection itself or all in combination led to this thrombotic event cannot be precisely established. Notwithstanding, we recommend serologic testing for HIV and HBV in patients suffering from CVT with high-risk behavior.

Prevalence of Mycobacterium tuberculosis in Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa.

BackgroundTuberculosis (TB) case finding efforts typically target symptomatic people attending health facilities. We compared the prevalence of Mycobacterium tuberculosis (Mtb) sputum culture-positivity among adult clinic attendees in rural South Africa with a concurrent, community-based estimate from the surrounding demographic surveillance area (DSA).MethodsClinic: Randomly selected adults (≥18 years) attending 2 primary healthcare clinics were interviewed and requested to give sputum for mycobacterial culture. Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) status were based on self-report and record review. Community: All adult (≥15 years) DSA residents were invited to a mobile clinic for health screening, including serological HIV testing; those with ≥1 TB symptom (cough, weight loss, night sweats, fever) or abnormal chest radiograph were asked for sputum.ResultsClinic: 2055 patients were enrolled (76.9% female; median age, 36 years); 1479 (72.0%) were classified HIV-positive (98.9% on ART) and 131 (6.4%) reported ≥1 TB symptom. Of 20/2055 (1.0% [95% CI, .6–1.5]) with Mtb culture-positive sputum, 14 (70%) reported no symptoms. Community: 10 320 residents were enrolled (68.3% female; median age, 38 years); 3105 (30.3%) tested HIV-positive (87.4% on ART) and 1091 (10.6%) reported ≥1 TB symptom. Of 58/10 320 (0.6% [95% CI, .4–.7]) with Mtb culture-positive sputum, 45 (77.6%) reported no symptoms. In both surveys, sputum culture positivity was associated with male sex and reporting >1 TB symptom.ConclusionsIn both clinic and community settings, most participants with Mtb culture-positive sputum were asymptomatic. TB screening based only on symptoms will miss many people with active disease in both settings.

Seroprevalence and associated risk factors of human immunodeficiency virus, hepatitis B virus and syphilis among pregnant women attending Dessie referral hospital, Northeast Ethiopia

<p><strong>Background</strong>: Globally the burden of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and syphilis infections are a common problem of pregnant women where the complications are transmitted to their new born infants. These infections, often silent and without symptoms, can result in serious and fatal health consequences.</p><p><strong>Methods</strong>: Cross-sectional study was conducted on 384 pregnant women attending Dessie referral hospital from February to April 2019 by using convenience sampling techniques. Data were collected by assigned nurses with face to face interview using a pre-tested questionnaire. Samples were screened by rapid serological tests for HIV and <em>T. pallidum </em>antibodies as well as HBsAg. Data was analysed using SPSS. Logistic regression was used to see the association between dependent and independent variables. P values <0.05 was considered as statistically significant. </p><p><strong>Results:</strong> The overall seroprevalence rates of HIV, HBsAg, syphilis and HIV/HBV coinfections were 6.5%, 4.7% and 0.8%, and 0.5% respectively. The history of sexual transmitted infections (STIs), multiple partners and using sharp materials were significantly associated to HIV with an adjusted odd ratio (AOR) of 8.35, 9.6 and 3.097 respectively. Likewise, the habit of ear/nose piercing and partner’s STIs exposure were associated with hepatitis B infection with an AOR 8.24 and 14.11 respectively.</p><p><strong>Conclusions:</strong> HIV and HBV infections are still critical public health concerns among pregnant women in the study area. History of multiple sexual partners, sharing of sharp materials, history of STIs exposure, habits of ear/nose piercing were significantly associated with infections.</p>

Knowledge of HIV status and antiretroviral therapy use among sexually transmitted infections service attendees and the case for improving the integration of services in South Africa: A cross sectional study.

We describe knowledge of human immunodeficiency virus (HIV) status, correct report of HIV status and antiretroviral therapy (ART) use among sexually transmitted infection (STI) service attendees in South Africa.An anonymous questionnaire was administered and serological HIV testing done. Proportions of attendees reporting knowledge of HIV status and HIV status consistent with laboratory results and ART use (among HIV positives) were determined as were factors associated with knowledge and inconsistent report of HIV status.Of 1054 attendees, 288 (27.3%) were HIV positive and 830 (78.8%) self-reported knowledge of HIV status. Not knowing one's HIV status was associated with male gender [adjusted Odds Ratio (aOR) 2.66 (95% confidence interval (CI) 1.70–4.18] medical circumcision [aOR 0.48 (95% CI 0.24–0.95)] and site [Gauteng Province (GP)-aOR 6.20 (95% CI 3.51–10.95), Eastern Cape (EC)-aOR 17.29 (95% CI 10.08– 29.66) versus Free State (FS)/Western Cape (WC) sites]. Of 219 HIV positive attendees with knowledge of HIV status, 136 (62.1%) self-reported being HIV positive, of whom 80 (58.8%) reported taking ARVs in the preceding 3 days. Inconsistent report of status was associated with males [aOR 2.26 (95%CI 1.05–4.87)], prior STI treatment [aOR 0.33 (95% CI 0.16–0.69)], recent HIV testing (6months) [aOR 3.20 (95% CI 1.62–6.36)] and site [GP-aOR 6.89 (95% 3.21–14.82), EC-aOR 5.08 (95% CI 2.15–11.64) versus FS/WC sites]. Knowledge of HIV status was lower than targeted. HIV testing and linkage to care services are essential in STI-related care and validation of self-reported indicators in this population maybe necessary.

Kaposi sarcoma in an HIV-negative Tunisian patient: A rare cause of metatarsalgia

BackgroundKaposi sarcoma (KS) is an angioproliferative neoplasm that is commonly associated with human herpes virus-8 (HHV-8) and human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). KS with osseous involvement is a rare occurrence, and is far more common in acquired immunodeficiency syndrome (AIDS)-related KS. Case presentationWe present a 32-year-old Tunisian man, HIV negative, who presented with a 4-year history of atraumatic mechanical metatarsalgia that progressively worsened with a limping gait. Physical examination revealed marked symmetrical forefoot lymphedema and a painful restricted left knee joint movement. Physical examination showed purple-blue plaques and nodules on the feet and ankles. Serologic tests for HIV and syphilis were negative. Plain radiography of the feet revealed numerous small lytic lesions. There were also scattered lytic lesions in the metaphysis of the proximal tibia and fibula. Osteolysis was predominantly left. Magnetic resonance imaging of the feet showed abnormal bone marrow signal of metatarsals and phalanges. Skin lesion biopsy yielded the diagnosis of Kaposi sarcoma. The disease was managed with chemotherapy including vinblastine. ConclusionIn a patient presenting with metatarsalgia without a commonly detected cause, it is mandatory to search for other lesions that may point to a rare diagnosis as KS which is famous for involvement of the metatarsal bone.

Silent HIV infection masquerading behind psoriasis

Psoriasis is a chronic inflammatory autoimmune skin disease characterized by immune-mediated cutaneous inflammation and keratinocyte hyperproliferation. Psoriasis can be the early presenting cutaneous manifestation in patients with human immunodeficiency virus (HIV) infection, acquired immunodeficiency syndrome. We report three patients presenting with severe extensive cutaneous psoriatic lesions, psoriatic arthritis, cachehxia, oesophagitis, “Tambaram tongue” in whom initial serological testing for HIV was negative, but Westernblot test confirmed the diagnosis of

Prevalence of Undiagnosed HIV Infection in Patients With Ocular Surface Squamous Neoplasia in a Tertiary Center in Karnataka, South India

To evaluate the prevalence of undiagnosed and asymptomatic human immunodeficiency virus (HIV) infection in patients with ocular surface squamous neoplasia (OSSN) in a referral hospital in Karnataka, South India. A consecutive series of patients presenting with OSSN were evaluated in an academic center during January 2009 to June 2010. A detailed history was obtained and physical examination in 25 consecutive patients with OSSN was performed. Twenty-three patients (88%) agreed to undergo serological HIV testing. Of these, 2 were excluded from the current study because they had xeroderma pigmentosa, a known predisposing factor for OSSN. Of the 21 patients, 6 (29%) patients were HIV positive. None of the patients had previous HIV testing. The median age of presentation among HIV-positive patients was 36 years, whereas it was 54 years among HIV-negative patients. The mean CD4 count in HIV-positive patients was 133 cells per mm, and all patients were started on antiretroviral treatment. The conjunctival tumor may be the primary and the only apparent manifestation of HIV in patients presenting with OSSN, and the ophthalmologist needs to be aware of this association.

A Case of Human Herpes Virus-8 Unrelated Primary Effusion Lymphoma-Like Lymphoma Presented as Pleural Effusion

Primary effusion lymphoma (PEL) is a rare type of lymphoma that arises in the body cavity without detectable masses. It is associated with human herpes virus-8 (HHV-8), Epstein-Barr virus (EBV), and human immunodeficiency virus (HIV). Recently, PEL unrelated to viral infection has been reported and it has been termed HHV-8 unrelated primary effusion lymphoma-like lymphoma (HHV-8 unrelated PEL-like lymphoma). Here, we report a case of HHV-8 unrelated PEL-like lymphoma in an 80-year-old woman. Chest X-ray and computed tomography revealed left-sided pleural effusion. Pleural effusion analysis and mediastinoscopic biopsy showed atypical cells that had originated from the B cells. The cells were positive for CD20 and bcl-2, but negative for CD3, CD5, CD21, CD30, CD138, epithelial membrane antigen, and HHV-8. Serological tests for HIV and EBV were negative. Considering the patient's age, further treatments were not performed. She has shown good prognosis without chemotherapy for more than 18 months.

Isolated homonymous hemianopsia due to presumptive cerebral tubercular abscess as the initial manifestation of human immunodeficiency virus infection

We report a case of isolated homonymous hemianopsia due to presumptive cerebral tubercular abscess as the initial manifestation of human immunodeficiency virus (HIV) infection. A 30-year-old man presented to our outpatient department with sudden loss of visibility in his left visual field. He had no other systemic symptoms. Perimetry showed left-sided incongruous homonymous hemianopsia denser above the horizontal meridian. Magnetic resonance imaging revealed irregular well-marginated lobulated lesions right temporo-occipital cerebral hemisphere and left high fronto-parietal cerebral hemisphere suggestive of brain tubercular abscess. Serological tests for HIV were reactive, and the patient was started only on anti-tubercular drugs with the presumptive diagnosis of cerebral tubercular abscess. Therapeutic response confirmed the diagnosis. Atypical ophthalmic manifestations may be the initial presenting feature in patients with HIV infection. This highlights the need for increased index of suspicion for HIV infection in young patients with atypical ophthalmic manifestations.

Long-term survival of a patient with bone marrow gelatinous degeneration of idiopathic origin

TO THE EDITOR: Gelatinous bone marrow transformation (GMT) is a rare bone marrow (BM) disorder of unknown pathogenesis. It is characterized by fat cell atrophy, focal loss of hematopoietic cells, and deposition of extracellular gelatinous substances (mucopolysaccharides rich in hyaluronic acid) [1]. The pathogenesis of GMT involves the deposition of hyaluronic acid, which hampers hematopoiesis by altering the BM microenvironment and stroma and disruption of the interactions between BM cells and cell signaling molecules [1]. GMT has been reported in association with chronic debilitating diseases, such as anorexia nervosa, malnutrition, and human immunodeficiency virus (HIV) infection, and after cytotoxic treatments [2]; in addition, GMT has been described in patients with myelodysplastic syndrome [3], acute myeloblastic leukemia [3], and idiopathic myelofibrosis [4]. However, idiopathic GMT has also been reported [5]. Herein, we report a case of idiopathic GMT in a patient who had an unusual clinical course and long-term survival. The patient was a 64-year-old Caribbean woman who had been living in Rome for more than 30 years. She was referred to our clinic in December 2005 because of anemia. Her past medical history was unremarkable. She did not use alcohol, drugs, or tobacco, and her nutritional status was excellent. Physical examination was unremarkable with the exception of pallor; the patient did not have either spleen or liver enlargement. A complete blood count at admission showed normochromic-normocytic anemia with reticulocytopenia and normal white blood cell and platelet counts. Total and unconjugated bilirubin and serum haptoglobin levels were normal. Direct and indirect indirect Coombs tests were negative. Serological tests for HIV, cytomegalovirus, Epstein-Barr virus, parvovirus B19, and hepatitis B and C viruses were negative. In addition, serum levels of tri-iodothyronine were normal. Moreover, no clinical or laboratory features of autoimmune disease were detected. Examination of peripheral blood smears revealed normal RBC; erythrocyte fragments were not detectable. Radiological examinations, which included a whole-body computed tomography scan, revealed no abnormalities. Occult blood loss was ruled out by fecal and urine analyses. A BM aspirate performed at admission resulted in a dry tap. Therefore, a BM trephine biopsy was taken. Histological examination of the BM sample revealed GMT (Fig. 1). The patient did not respond to any potentially disease-modifying treatment, including erythropoietin, prednisone, and cyclosporine. Therefore, she was managed with supportive measures, primarily transfusions. The clinical course was uncomplicated and her hematological status has remained stable. To date, 80 months after the diagnosis, she is managed only with supportive measures, consisting of 2 units of packed RBC every 3 weeks, along with iron chelation therapy. In addition, her BM features, which have been evaluated annually by BM trephine biopsies, have remained stable. In conclusion, we have described a case of an apparently healthy woman who presented with GMT approximately 7 years ago, in whom anemia was the only clinical manifestation of hematopoietic impairment. To the best of our knowledge, no such case of GMT has been reported previously as an idiopathic primary condition. Fig. 1 Serous atrophy in a diffuse and severe hypocellular background (A). Reduced fat cells, a diffuse extracellular gelatinous amorphous material, small typical lymphocytes, and mature plasma cells were also observed (B). Small islets of hematopoietic cells ...

Transmission of human immunodeficiency virus and hepatitis C virus through liver transplantation

We are writing in regard to a recently published article by Ahn and Cohen documenting the transmission of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) to a liver recipient, 2 kidney recipients, and 1 heart recipient.1 The authors clearly present the case from their patients' perspective, allowing the transplant community to review many of the facts regarding their care. The authors state in the abstract and in the discussion that the transmission occurred secondary to the donor being within the window period between initial infection and detection of antibodies. This is factually incorrect because it has not been clearly confirmed and hemodilution may have contributed to the lack of detection. To date, confirmatory serologic and molecular testing has been conducted only on residual blood drawn on the donor post-transfusion. Because of legal proceedings, the pretransfusion blood has not had confirmatory serologic or molecular testing. Until this is done, it is impossible to determine whether the negative serologic testing that was reported to the centers at the time of the organ offer represented a true negative because the patient was in the window period or if the blood and fluids that the donor had received prior to specimen collection diluted the sample. Second, an important recommendation from the 1994 Public Health Services Guidelines is not included in the discussion2: the need for posttransplant testing of all recipients of organs from increased-risk donors. This not only is an oversight in the article and in its accompanying editorial1, 3 but also is missing from most discussions on this topic. The guidelines clearly recommend that all recipients of organs from increased-risk donors “be tested for HIV immediately before transplantation and at 3 months following transplantation.” This case demonstrates some key issues to guide the testing of recipients. First, the patient, like the other transplant recipients, acquired HCV infection without seroconversion; as such, posttransplant testing should use both molecular and serologic methods. Second, although we cannot be sure that earlier testing would have affected the overall course of the patient, it is possible that early identification and treatment of the HIV and HCV infection in the recipient may have improved her outcome. Since the transmission event, at our center, we perform baseline serologic testing for HIV, hepatitis B virus, and HCV immediately preoperatively in all recipients of organs from increased-risk donors, and this is followed by serologic and molecular (quantitative polymerase chain reaction) testing for HIV, hepatitis B virus, and HCV, unless there was pretransplant documentation of protection or infection, at 1 and 3 months post-transplant. Such testing is just as important as the consent of recipients of organs from increased-risk donors. Finally, current Organ Procurement and Transplantation Network policy requires reporting of any donor-derived disease transmission if it is recognized to allow appropriate screening and care of other recipients.4 Michael G. Ison*, John J. Friedewald , * Divisions of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, Divisions of Nephrology, and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL.

The Role of Human Immunodeficiency Virus Infection in Infranuclear Facial Paralysis

This study describes the pattern of idiopathic infranuclear facial palsy (facial neuropathy) and highlights the role of human immunodeficiency virus (HIV)/AIDS in its occurrence and management. This study conducted in Ile-Ife, Nigeria, assessed individuals with idiopathic facial neuropathy seen at the neurology; maxillofacial surgery; and ear, nose and throat outpatient clinics between 1994 and 2006. Eighty-eight patients with idiopathic facial neuropathy were seen during the 13-year study period. Forty-six (52.3%) were males, and the age range was 15 to 76 years, with a median of 35.5 years and interquartile range of 24.5 to 54 years. The right side was affected in 59.1%, compared with 40.9% on the left side. Twenty-six patients (29.5%) were HIV positive at presentation: 16 males, 10 females; mean age for HIV-positive patients was 29.15 +/- 8.12 years and 44.39 +/- 18.48 years for HIV-negative patients. There was a significant relationship among the status of the patients and the severity at presentation (p = .035), treatment given (p = .019), and the occurrence of flu-like symptoms (p = .004). A high index of suspicion of seroconversion is essential in patients presenting with idiopathic facial neuropathy since it has implications for management. Serological testing for HIV, especially in patients at risk and those with history of recent flu-like symptoms, is recommended.

Index of Suspicion

Index of Suspicion

Effect of herpes simplex suppression on incidence of HIV among women in Tanzania.

Infection with herpes simplex virus type 2 (HSV-2) is associated with an increased risk of acquiring infection with the human immunodeficiency virus (HIV). This study tested the hypothesis that HSV-2 suppressive therapy reduces the risk of HIV acquisition. Female workers at recreational facilities in northwestern Tanzania who were 16 to 35 years of age were interviewed and underwent serologic testing for HIV and HSV-2. We enrolled female workers who were HIV-seronegative and HSV-2-seropositive in a randomized, double-blind, placebo-controlled trial of suppressive treatment with acyclovir (400 mg twice daily). Participants attended mobile clinics every 3 months for a follow-up period of 12 to 30 months, depending on enrollment date. The primary outcome was the incidence of infection with HIV. We used a modified intention-to-treat analysis; data for participants who became pregnant were censored. Adherence to treatment was estimated by a tablet count at each visit. A total of 821 participants were randomly assigned to receive acyclovir (400 participants) or placebo (421 participants); 679 (83%) completed follow-up. Mean follow-up for the acyclovir and placebo groups was 1.52 and 1.62 years, respectively. The incidence of HIV infection was 4.27 per 100 person-years (27 participants in the acyclovir group and 28 in the placebo group), and there was no overall effect of acyclovir on the incidence of HIV (rate ratio for the acyclovir group, 1.08; 95% confidence interval, 0.64 to 1.83). The estimated median adherence was 90%. Genital HSV was detected in a similar proportion of participants in the two study groups at 6, 12, and 24 months. No serious adverse events were attributable to treatment with acyclovir. These data show no evidence that acyclovir (400 mg twice daily) as HSV suppressive therapy decreases the incidence of infection with HIV. (Current Controlled Trials number, ISRCTN35385041 [controlled-trials.com].).

General paralysis of the insane and AIDS in old age psychiatry: epidemiology, clinical diagnosis, serology and ethics--the way forward.

While the incidence of general paralysis of the insane (GPI) has declined, AIDS (acquired immune deficiency syndrome) has emerged as a new illness. Today, in England and Wales, as many elderly people die from AIDS as from neurosyphilis, although both diagnoses are rare in this age group. Both are serious medical conditions with psychiatric manifestations. For both, serological tests may identify the disease, and treatment may be of benefit, but there is considerable social stigma attached to the diagnoses. Ethical guidelines for serological testing for HIV (human immunodeficiency virus) have been available for over a decade. In view of the similarities between the diseases, it may be unethical to test patients for syphilis routinely. Epidemiology, risk factors, neurological and neuropsychiatric features and ethics must be considered before testing for both syphilis and HIV.

HIV transmission, healthcare workers and media hype.

Early in the acquired immunodeficiency syndrome (AIDS) epidemic, healthcare workers (HCWs) caring for AIDS patients recognized the potential for transmission of AIDS in the workplace. Discovery of the human immunodeficiency virus (HIV) and the development and application of serologic testing for HIV caused many HCWs to breathe a sigh of relief. A. few were not so fortunate. The plethora of information related to HIV transmission published thus far has relieved most HCWs, for in fact the of nosocomial infection appears and is seemingly related to direct exposure to blood. However, recent events suggest a growing concern among HCWs related to their of occupational exposure and infection. Notably, a surgeon from San Francisco, California recently appeared on ABC's Nightline and CBS' 60 Minutes and suggested that the occupational of HIV infection is underestimated by AIDS experts. The two programs alluded to or directly accused several AIDS researchers and agencies of obscuring data and misleading HCWs with regard to HIV transmission in the workplace. This national media attention properly jars HCWs into examining the facts and figures behind the statement that there is a low risk of becoming infected in the workplace. This editorial attempts to summarize the approaches employed to determine occupational risk. of HIV and to put occupational and prevention in perspective. Although several retrospective cases of occupational HIV infection have been reported, these reports provide little insight into the degree of per exposure. The best data related to HIV transmis-