HIV and AIDS: information and guidance in the occupational setting
HIV (Human Immuno-deficiency Virus) is the infection which through progressive destruction of specific immune cells (CD4 cells) leads to AIDS. Opportunistic infections, specific malignancies, HIV wasting or HIV encephalopathy are part of a complex case definition which comprise the Acquired Immuno Deficiency Syndrome.
HIV is a sexually transmitted and bloodborne virus (BBV). This means it can be transmitted by unprotected sexual intercourse or by routes similar to other BBVs i.e. shared needle use by injecting drug users, needlestick injuries in healthcare workers, or mother to child transmission before, during or after (via breast milk from an infected mother) the birth of the child.
In countries which can afford anti-retroviral therapies the progression to AIDS is not inevitable and the patterns of survival have been fundamentally changed by these drugs. However, there is currently no cure and patients need to continue on therapy. There is currently no effective vaccine although much research is going on to try to develop one.
Preventing infection in the occupational setting
General prevention
Specific to procedure
- Wear protective gloves and face masks
- Cover cuts and wounds with waterproof dressing
- Never re-sheath needles
- Use disposable sterile needles
- Ensure all equipment is approprately sterilised
- Wash your hands after any incident involving blood.
The Control of Substances Hazardous to Health Regulations 2002 (COSHH) requires both employers and employees to take responsibility to avoid any risk where possible e.g. safe handling and disposal of sharps and the use of personal protective equipment (gloves, face visors) to minimise exposure to blood or body fluids. Employees are required under COSHH to perform their own assessment of risk and to implement necessary measures to protect both themselves and others.
Specific to injury
Post-Exposure Prophylaxis (PEP): anti-retroviral drugs for exposure to HIV
These drugs are used primarily to treat HIV infection in patients, to prevent transmission from an HIV positive mother, and to prevent HIV infection in healthcare workers following exposures at work e.g. needlestick injuries.
A case-control study in 1997, suggested that the use of Zidovudine as PEP reduced by 80% the risk of healthcare workers acquiring HIV following an occupational exposure to HIV-infected blood [1].
Triple anti-retroviral therapy is standard PEP for HIV occupational exposures in the UK.
The Department of Health in the UK issued the first formal guidelines in 1997, the most recent updates being in February 2004 and July 2008 [2].
For more detailed information on PEP please see reference 2.
References:
1. Cardo DM, Culver DH, Ciesielski CA, Srivastava PU, Marcus R, Abiteboul D, et al. A Case-Control Study of HIV Seroconversion in Health Care Workers After Percutaneous Exposure.
N Engl J Med 1997; 337:1485-90
The use of anti-retroviral drugs as HIV post-exposure prophylaxis (PEP) is standard practice following an occupational exposure. Active surveillance of PEP management following exposures to HIV or where the HIV status is unknown (high-risk exposure) has been undertaken in the UK since July 1997.
Occupationally acquired HIV
There have been five documented cases of occupationally acquired HIV infections in healthcare workers in the UK. A further 14 probable cases of occupational acquisition of HIV in healthcare workers have been diagnosed in the UK. The majority of these healthcare workers had worked in countries of high HIV prevalence, and are presumed to have been infected outside of the UK.
Heptonstall J, Gill ON, Porter K, Black MB, Gilbart VL. Health care workers and HIV: surveillance of occupationally acquired infection in the United Kingdom. Commun Dis Rep CDR Rev 1993; 3:R147-53
Hawkins D A, Asboe D, Barlow K and Evans B. Seroconversion to HIV-1 Following a needlestick injury despite combination post exposure prophylaxis. J Infection 2001; 44: 12-8
Occupational transmission of HIV. Summary of published reports. March 2005 Edition. Data to the end of December 2002. Health Protection Agency Centre for Infections and Collaborators. (PDF, 274 KB)Specific occupational health guidelines
Related Information
Last reviewed: 8 March 2010
