A Case–Control Study of HIV Seroconversion in Health Care Workers after Percutaneous Exposure
Denise M. Cardo, M.D., David H. Culver, Ph.D., Carol A. Ciesielski, M.D., Pamela U. Srivastava, M.S., Ruthanne Marcus, M.P.H., Dominique Abiteboul, M.D., Julia Heptonstall, M.R.C.Path., Giuseppe Ippolito, M.D., Florence Lot, M.D., Penny S. McKibben, David M. Bell, M.D., for The Centers for Disease Control and Prevention Needlestick Surveillance Group
Background The average risk of human immunodeficiency virus(HIV) infection after percutaneous exposure to HIV-infectedblood is 0.3 percent, but the factors that influence this riskare not well understood.
Methods We conducted a case–control study of health careworkers with occupational, percutaneous exposure to HIV-infectedblood. The case patients were those who became seropositiveafter exposure to HIV, as reported by national surveillancesystems in France, Italy, the United Kingdom, and the UnitedStates. The controls were health care workers in a prospectivesurveillance project who were exposed to HIV but did not seroconvert.
Results Logistic-regression analysis based on 33 case patientsand 665 controls showed that significant risk factors for seroconversionwere deep injury (odds ratio = 15; 95 percent confidence interval,6.0 to 41), injury with a device that was visibly contaminatedwith the source patient's blood (odds ratio = 6.2; 95 percentconfidence interval, 2.2 to 21), a procedure involving a needleplaced in the source patient's artery or vein (odds ratio =4.3; 95 percent confidence interval, 1.7 to 12), and exposureto a source patient who died of the acquired immunodeficiencysyndrome within two months afterward (odds ratio = 5.6; 95 percentconfidence interval, 2.0 to 16). The case patients were significantlyless likely than the controls to have taken zidovudine afterthe exposure (odds ratio = 0.19; 95 percent confidence interval,0.06 to 0.52).
Conclusions The risk of HIV infection after percutaneous exposureincreases with a larger volume of blood and, probably, a highertiter of HIV in the source patient's blood. Postexposure prophylaxiswith zidovudine appears to be protective.
Source Information
From the Hospital Infections Program, National Center for Infectious Diseases (D.M.C., D.H.C., P.U.S., R.M., P.S.M., D.M.B.), and the Division of HIV/AIDS, National Center for HIV, STD, and TB Prevention (C.A.C.), Centers for Disease Control and Prevention, Atlanta; the Institut National de Recherche et de Sécurité and Groupe d'Étude sur le Risque d'Exposition au Sang, Paris (D.A.); the Public Health Laboratory Service Communicable Disease Surveillance Centre, London (J.H.); the Centro di Riferimento AIDS–Coordinamento Studio Italiano sul Rischio di Infezione Occupazionale da HIV, Rome (G.I.); and the Réseau National de Santé Publique, Saint Maurice, France (F.L.).
Address reprint requests to Dr. Cardo at the Centers for Disease Control and Prevention, 1600 Clifton Rd., Mail Stop E-68, Atlanta, GA 30333.
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