OCCUPATIONAL EXPOSURE TO HUMAN-IMMUNODEFICIENCY-VIRUS - WHAT HEALTH-CARE PROVIDERS SHOULD KNOW

PURPOSE: The author reviews the risks of occupational exposure to HIV and provides a rationale for new postexposure guidelines for healthcar e workers. OVERVIEW: Approximately 50,000 percutaneous exposures occur yearly among healthcare workers in the United States. Of these, appro ximately 5000 involve exposures to blood that is known to be infected with HIV. The risk of transmission after percutaneous exposure to HIV- tainted blood has been estimated to be 0.3%, but the risk may be consi derably higher to the healthcare worker if any of the following is pre sent: a deep injury; visible blood on the sharp device; a procedure th at involves a needle placed in the patient's artery or vein; and a pat ient with advanced AIDS. The increasing resistance of HIV strains to a ntiretroviral therapy continues to make treatment more difficult. CLIN ICAL IMPLICATIONS: Postexposure prophylaxis with zidovudine may reduce the risk of occupational infection by 80%. Advances in the ability to ameliorate HIV transmission rates and to treat individuals with resis tant disease through innovations in drug therapy, engineering of contr ols for injury prevention, and more focused postexposure evaluation of fer the hope of reducing this infrequent, but dangerous, occupational threat.