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

• Guidance for clinical healthcare workers: protection against infection with bloodborne viruses. London: UK Health Departments, 1998
• Standard principles for preventing hospital-acquired infections.
   J Hosp Infect 2001; 47(Supplement): S21-S37

 

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.

• Guidance for clinical healthcare workers: protection against infection with bloodborne viruses. London: UK Health Departments, 1998

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 ² and July 2007 ³.

For more detailed information on PEP please see references 2 and 3.

 

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

2. HIV Post-Exposure Prophylaxis: Guidance from the UK Chief Medical Officers' Expert Advisory Group on AIDS. London: Department of Health, February 2004

3. Public Health Link: Update to HIV post-exposure prophylaxis (PEP) guidance from the Expert Advisory Group on AIDS (EAGA) following the recent recall of Viracept. July 2007

 

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.

See report: Eye of the Needle - United Kingdom Surveillance of Significant Occupational Exposure to Bloodborne Viruses in Healthcare Workers. November 2006

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)

Occupational transmission of HIV. Summary of published reports. December 1999 Edition. Data to the end of June 1999. HIV and STI Division Communicable Disease Surveillance Centre and Collaborators. This is a collection of international reports (PDF, 460 KB)

Specific occupational health guidelines

HIV Infected Health Care Workers: Guidance on Management and Patient Notification. London: Department of Health, July 2005

Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers. London: Department of Health, March 2007

Related Information

• Occupational exposure and bloodborne viruses
• HIV
• Definition of healthcare workers

Last reviewed: 17 April 2008