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ObjectiveAmong HIV-infected persons, we evaluated use of client partner notification (CPN) and health-department partner notification strategies to inform sex partners of possible HIV exposure, and prior exposure to partner counseling and referral services.MethodsWe conducted a cross-sectional, observational study of 590 persons diagnosed with HIV in the prior 6 months at 51 HIV test, medical, and research providers in Chicago and Los Angeles in 2003 and 2004. Logistic regression was used to identify independent correlates of using CPN to notify all locatable partners.ResultsParticipants reported a total of 5091 sex partners in the 6 months preceding HIV diagnosis; 1253 (24.6%) partners were locatable and not known to be HIV-positive. Of 439 participants with ≥1 locatable partners, 332 (75.6%) reported notifying 696 (55.5%) partners by CPN (585, 84.1%), health-department partner notification (94, 13.5%), or other means (17, 2.4%); 208 (47.4%) used CPN to notify all locatable partners. Independent correlates of CPN included having fewer locatable partners and discussing the need to notify partners with an HIV medical-care provider (black and Hispanic participants only). Many participants reported that their HIV test or medical-care provider did not discuss the need to notify partners (48.8%, 33.7%, respectively) and did not offer health-department partner-notification services (60.8%, 52.8%).ConclusionMany locatable sex partners who might benefit from being notified of potential HIV exposure are not notified. In accordance with national policies, HIV test and medical-care providers should routinely provide partner counseling and referral services to HIV-infected clients so that all locatable partners are notified and provided an opportunity to learn their HIV status.

HIV transmission resulting from needlesticks and cuts may increase with exposure to more infected blood and higher blood levels of virus. Analysis of 33 health care workers who contracted HIV and 665 others who remained HIV-free after exposure points to deep injury, puncture with a bloody needle, and injury with blood from a terminally-ill AIDS patient as significant risk factors. Postexposure treatment with zidovudine (AZT) reduced the risk of infection about 81%. Health care workers face an estimated 0.3% risk of contracting HIV when they are exposed to infected blood through broken skin.

The case of a 48-year-old health care worker illustrates the potentially deadly interaction between HIV and the hepatitis C virus. She was stuck by a needle used on an AIDS patient. She tested negative for HIV up to 8 months after this exposure. However, 10 months after exposure, she became ill and an HIV test at that time was positive. After she developed signs of liver dysfunction, she was tested for hepatitis C virus and was found to be positive. Eighteen months after becoming HIV-positive, she died of liver and kidney failure. Her viral isolates were closely related to those isolated from the AIDS patient.

The risk of patient-to-patient transmission of HIV infection from contaminated dental instruments may be low. Five patients of a Florida dentist with AIDS were infected with HIV reportedly as the result of dentist-to-patient transmission. A study examined 185 patient and dental practice records from the office of the Florida dentist between Nov 1987 and Jul 1989. Two of four case patients were treated on the same day on four different occasions. The remaining case patient was never treated on the same day as any of the other patients. Certain dental instruments may have been used on both of the case patients treated on the same day. On 43 different occasions, 78 patients who were HIV-negative one year after the practice closed in 1989 were treated on the same day as one of the case patients. Some of the HIV-negative patients received treatments similar to those received by the case patients. The case patients were probably infected through direct exposure to the dentist's blood.

National surveillance data regarding AIDS are an important source for determining the status of occupationally-acquired HIV infection. These data include information on whether or not a patient with AIDS was a health care worker at any time since 1978 as well as a patient's risks for acquiring HIV infection. This study evaluated data regarding health care workers who developed AIDS. Data on each case of AIDS are reported to the Centers for Disease Controls (CDC). Investigations are made for any case involving a health care worker who reports no nonoccupational risk for HIV infection. As of June 30, 1990, 5,425 cases of AIDS involving health care workers had been reported to the CDC. Demographically, these cases resemble all AIDS cases. Initially, 539 cases reported no nonoccupational risks for HIV infection. Of 303 cases carefully reevaluated, nonoccupational risks for HIV infection were found for 237 cases. Overall, no nonoccupational risks for HIV infection are known for 305 of the 5,425 cases (5.6 percent). For all reported AIDS cases, 2.8 percent of cases involve an undetermined risk for the infection. In only 3 cases was HIV infection confirmed as having been caused by an occupational risk. These results show that almost all health care workers who developed AIDS during the study period were infected with HIV by a nonoccupational means. (Consumer Summary produced by Reliance Medical Information, Inc.)

Acquired immunodeficiency syndrome (AIDS) cases reported as the result of heterosexual contact have been increasing in the United States, with Florida reporting a disproportionate number. We investigated 168 such AIDS cases from southern Florida. After follow-up, 50 (30%) patients were reclassified into other transmission categories. The data suggest that the increased rate of heterosexually acquired AIDS cases reported from southern Florida was partially related to misclassification of risk. (Am J Public Health 1993;83: 571-573), The increasing number of AIDS cases reported in southern Florida as transmitted by heterosexual intercourse may be explained by misclassification. In the US, HIV is spread mostly through homosexual intercourse and injection drug use. However, the number of cases resulting from heterosexual intercourse has been increasing, and 24% of these reported cases have been from Florida. Of 168 AIDS cases attributed to heterosexual intercourse, all had either had intercourse with a bisexual man, injected drugs or been born in a country where heterosexual transmission is the primary means of transmission. After interviewing the patients and reviewing their files, 50 (29.8%) were reclassified into another category of HIV transmission. Women still had a higher rate of heterosexually transmitted HIV than men. After adjustment, the increase in heterosexually transmitted AIDS was found to occur at a lesser rate than previously reported.

Public Health in East and Southeast Asia: Challenges and Opportunities in the Twenty-First Century Roger Detels, Sheena G. Sullivan, Chorh Chuan Tan, editors University of California Press, Berkeley, California, USA, [...]

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. (N Engl J Med 1997;337:1485-90.) [ABSTRACT FROM AUTHOR]