HTLV-III infection among health care workers. Association with needle-stick injuries
S. H. Weiss, W. C. Saxinger, D. Rechtman, M. H. Grieco, J. Nadler, S. Holman, H. M. Ginzburg, J. E. Groopman, J. J. Goedert, P. D. Markham and al. et
Health care workers are caring for an increasing number of persons infected
with human T-cell lymphotropic virus type III (HTLV-III), the primary
etiologic agent of the acquired immunodeficiency syndrome (AIDS). We
studied 361 health care and clinical laboratory personnel from institutions
in several metropolitan areas with both high and moderate levels of
HTLV-III infection among high-risk group members to evaluate routes of
exposure to and seropositivity for HTLV-III. Protection of the privacy of
subjects and prospective determination of risk factors were integral
components of the study design. Six (26%) of 23 health care workers with
recognized risk factors for AIDS had HTLV-III antibodies. Thirty-nine (14%)
of 278 workers at one institution as well as a total of five workers from
other institutions reported possible percutaneous exposure to HTLV-III,
usually injuries with needles that had been used on AIDS patients. There
were three HTLV-III seropositive subjects who reported possible parenteral
exposure to HTLV-III but no recognized AIDS risk factors. One was a
symptomatic female, subject A, and her apparent sources of HTLV-III
exposure were two puncture wounds, without injection of blood, made with
needles used on AIDS patients. Human T-cell lymphotropic virus type III was
cultured from her asymptomatic, seronegative long-term sexual partner,
apparently representing female-to-male transmission. For the two other
seropositive workers (subjects B and C) with nosocomial parenteral
exposure, we could not rule out heterosexual transmission as a possible
source of HTLV-III exposure. These latter two cases as well as the
identification of seropositive health care providers from known risk groups
point to the need for thorough case investigation to identify routes of
exposure in health care workers. The risk of nosocomial HTLV-III
transmission appears to be low and related to percutaneous exposure.
Medical personnel should be trained systematically in the proper techniques
and handling of instruments for phlebotomy and similar procedures to
decrease occupational exposure to HTLV-III.
