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Volume 337:1485-1490 November 20, 1997 Number 21 Next

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ABSTRACT

Background The average risk of human immunodeficiency virus (HIV) infection after percutaneous exposure to HIV-infected blood is 0.3 percent, but the factors that influence this risk are not well understood.

Methods We conducted a case–control study of health care workers with occupational, percutaneous exposure to HIV-infected blood. The case patients were those who became seropositive after exposure to HIV, as reported by national surveillance systems in France, Italy, the United Kingdom, and the United States. The controls were health care workers in a prospective surveillance project who were exposed to HIV but did not seroconvert.

Results Logistic-regression analysis based on 33 case patients and 665 controls showed that significant risk factors for seroconversion were deep injury (odds ratio = 15; 95 percent confidence interval, 6.0 to 41), injury with a device that was visibly contaminated with the source patient's blood (odds ratio = 6.2; 95 percent confidence interval, 2.2 to 21), a procedure involving a needle placed in the source patient's artery or vein (odds ratio = 4.3; 95 percent confidence interval, 1.7 to 12), and exposure to a source patient who died of the acquired immunodeficiency syndrome within two months afterward (odds ratio = 5.6; 95 percent confidence interval, 2.0 to 16). The case patients were significantly less likely than the controls to have taken zidovudine after the exposure (odds ratio = 0.19; 95 percent confidence interval, 0.06 to 0.52).

Conclusions The risk of HIV infection after percutaneous exposure increases with a larger volume of blood and, probably, a higher titer of HIV in the source patient's blood. Postexposure prophylaxis with 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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