Very low seroconversion rates after occupational exposure to HCV or HIV in body fluids

Last Updated: 2017-05-08

By Will Boggs MD

NEW YORK (Reuters Health) - Healthcare workers exposed to body fluids contaminated with hepatitis C virus (HCV) or the human immunodeficiency virus (HIV) face very low rates of seroconversion, researchers report.

"The significant improvements in safety practices and the implementation of antiretroviral therapy should be considered major victories for science, public health, and infection control,�€ Dr. Francesco M. Egro from the University of Pittsburgh Medical Center (UPMC) in Pennsylvania told Reuters Health by email.

Still, he cautioned, �€œphysicians and other healthcare workers need to maintain the rigorous practices developed so far and strive to identify new ways to create a safer environment for patients and healthcare workers alike.�€

An estimated 926,000 healthcare personnel around the world are exposed annually to HCV and 327,000 to HIV through sharps-related injuries, resulting in 16,400 new HCV infections and 1,000 new HIV infections among healthcare workers.

In two reports released online April 24th in the American Journal of Infection Control, Dr. Egro and colleagues describe their 13-year experience based on a prospectively maintained database of reported occupational injuries at UPMC.

During this time, there were 1,361 cases of HCV exposure and 266 cases of HIV exposure, mostly caused by percutaneous injuries, followed by mucocutaneous injuries.

Only two healthcare personnel became infected with HCV after percutaneous or mucocutaneous exposure (for a seroconversion rate of 0.1%), and two seroconverted after blood exposure via a hollow-bore needle (a rate of 0.2%).

By comparison, overall HCV seroconversion rates in the literature averaged 0.7%.

There were no cases of detectable HCV RNA without subsequent seroconversion.

There were no seroconversions among the healthcare workers exposed to HIV, 21.2% of whom received HIV postexposure prophylaxis (i.e., a seroconversion rate of 0%). This compares favorably with an overall HIV seroconversion rate of 0.13% reported in the literature.

�€œHealthcare workers exposed to HIV-contaminated body fluids should follow the recommendations provided by the U.S. Public Health Service and the Centers for Disease Control and Prevention, and promptly initiate postexposure prophylaxis if indicated,�€ Dr. Egro said. �€œOur HIV study did not specifically examine the impact of postexposure prophylaxis on seroconversion and thus no conclusions on the matter can be made. However, the fact that no patients seroconverted despite (the fact that) only 21% of exposed healthcare workers received postexposure prophylaxis, highlights the importance of conducting further animal and clinical studies on timing of administration.�€

�€œOnly through research, innovation, and collaboration can we create a safe work environment and eradicate the transmission of transmissible diseases such as HIV and hepatitis C,�€ he concluded.

Dr. Bruno Pozzetto from University-Hospital of Saint-Etienne and Faculty of Medicine Jacques Lisfranc, University Jean Monnet of Saint-Etienne, Saint-Etienne, France, who has also studied healthcare-associated HCV infection, told Reuters Health by email, "In case of exposure to a seropositive subject, healthcare workers must be (reassured): (i) seroconversion is a very rare event (the figures of this study can be used); (ii) in case of contamination, a spontaneous clearance of HCV RNA occurs in about one quarter of (cases); (iii) even in case of chronic infection . . . rapid treatment with recent direct antiviral drugs allows a definite cure in more than 99% of the cases.�€

�€œWith the ability of new treatments to cure HCV, the rate of exposure will continue to decrease during the next years,�€ he said. �€œIt is expected that the number of HCV-infected patients that was relatively high in the past years in hospitals will continue to decrease dramatically, which will result in a decreasing risk of getting contaminated during care-giving procedures. This goal is a further reason to propose an antiviral treatment to the majority of subjects that are chronically infected by HCV.�€

SOURCE: http://bit.ly/2pYd2Rf and http://bit.ly/2qJPsut

Am J Infect Control 2017.