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EC concerted action on accidental exposure to HIV-1 and other retroviruses

Objective

The general objective of this Concerted Action was to study adverse exposures to HIV-infected patients in major centres with a well defined protocol.
The specific objectives were:
- To study the pathogenesis of transmission of HIV-1 and other retroviruses through percutaneous injuries, mucous membrane contact, and other adverse exposures;
- To describe the circumstances of these adverse exposures, including infection control precautions in use at the time;
- To record the clinical and laboratory features of acute HIV infection in exposed workers who become infected (the window period; prognostic markers of infection; the pathogenic course of hypothetically different virus strains; characteristics of the source case);
- To observe the subsequent natural history of HIV infection in those occupationally infected workers with documented seroconversion;
- To make available information to assist post-exposure counselling of occupationally exposed workers;
- To provide information for health authorities on occupationally acquired HIV-1 and other retrovirus infections in different European countries.
Health care workers have frequent occupational exposure to human immunodeficiency virus (HIV-1) though the rate of transmission appears to be low: about 0.3%, or 3 per 1000 percutaneous exposures according to studies carried out in United States health care workers. In Europe, numerous case reports describing individual incidents of occupational transmission have been published, but these do not allow calculation of the magnitude of risk since no denominators are available. Given the infrequent occurrence of occupational HIV transmission, it was decided to carry out a multicenter prospective study of the subject which would combine data from a number of European countries. 10 European Community (EC) and 3 Cooperation in the field of Scientific and Technical Research (COST) countries have agreed to participate in this study of occupational exposure to HIV in health care workers. Through 31 December 1993, 4 countries have submitted 477 questionnaires reporting cases of accidental exposures: Spain (269), United Kingdom (140), Greece (40) and Denmark (28). Of the 477 exposures, 264 (55.3%) have been followed up for at least 6 months. 2 seroconversions have been detected, both following hollow bore needlestick accidents in the United Kingdom, giving an overall transmission rate of 0.76%. Most exposures have been in nurses (54.9%), followed by physicians (26.8%) and nursing assistants (9.2%). Over two thirds of the accidents (71.1%) involved percutaneous injuries (mostly needlesticks), while 27.3% were mucocutaneous exposures. In addition, summary data are available from:
Madrid, Spain (2 seroconversions among 1290 exposures, for a transmission rate of 0.16%);
Italy (3 seroconversions among 1727 exposures, for a rate of 0.17%);
France (3 seroconversions among 769 exposures, for a rate of 0.5%);
Switzerland (362 exposures);
Sweden (42 exposures);
Finland (3 exposures). 7 of the 8 seroconversions detected in these studies have occurred in nurses and 7 of 8 were the result of accidents with hollow bore needles. Only one seroconversion (in Italy) has occurred as a result of mucocutaneous exposure.
Health care workers have frequent occupational exposure to HIV-1, through the rate of transmission appears to be low: about 0.3%, or 3 per 1000 percutaneous exposures, according to studies carried out in US health care workers. In Europe, numerous cases reports describing individual incidents of occupational transmission have been published, but these do not allow calculation of the magnitude of risk since no denominators are available. Given the infrequent occurrence of occupational HIV transmission, it was decided to carry out a multicenter prospective study of the subject which would combine data from a number of European countries. To date, ten EC and three COST countries have agreed to participate in this study of occupational exposure to HIV in health care workers, now ending its second year.

Through 31 December 1993, four countries have submitted 477 questionnaires reporting cases of accidental exposure: Spain (269), United Kingdom (140), Greece (40) and Denmark (28). Of the 477 exposures, 264 (55.3%) have been followed up for at least 6 months. Two seroconversions have been detected, both following hollow bore needlestick accidents in the United Kingdom, giving an overall transmission rate of 2/264 or 0.76%.

Most exposures have been in nurses (54.9%), followed by physicians (26.8%) and nursing assistants (9.2%). Over two-thirds of the accidents (71.1%) involved percutaneous injuries (mostly needlesticks), while 27.3% were mucocutaneous exposures. Thirty persons received prophylaxis with zidovudine (ZDV): 16 from Greece (40% of that country's reported exposures), and 14 from Spain (5% of their reported exposures).

In addition, summary data are available from the Autonomous Community of Madrid, Spain (2 seroconversions among 1290 exposures, for a transmission rate of 0.16%); Italy (3 seroconversions among 1727 exposures, for a rate of 0.17%); France (3 seroconversions among 769 exposures, for a rate of 0.5%); Switzerland (362 exposures); Sweden (42 exposures); and Finland (3 exposures). Seven of the eight seroconversions detected din these studies have occurred in nurses (occupation for one was not reported), and seven of eight were the result of accidents with hollow-bore needles. Only one seroconversion (in Italy) has occurred as a results of mucocutaneous exposure.

Funding Scheme

CON - Coordination of research actions

Coordinator

Instituto de Salud Carlos III
Address
Majadahonda
28220 Madrid
Spain