Possible occupationally acquired HIV infection in two Indian healthcare workers.

In healthcare settings, avoiding occupational blood exposure is the best way to prevent transmission of HIV infection.[1] There are several considerations for postexposure prophylaxis (PEP) for HIV and there are several sources of information about the use and safety of HIV PEP. There are also concerns regarding PEP regimens when the source person's virus is known or suspected to be resistant to 1 or more of the antiretroviral agents that might be used for PEP. In addition, unnecessary use of antiretroviral drugs should be avoided; data indicate that some healthcare workers (HCW) have taken a full course of HIV PEP after exposures that do not carry a risk of HIV transmission.[2] In prospective studies of HCW, the average risk of HIV transmission after a percutaneous exposure to HIV-infected blood has been estimated to be approximately 0.3% and after a mucous membrane exposure, approximately 0.09%.[3,4] Data collected on needlestick injuries in the United States by the US Centers for Disease Control and Prevention (CDC) may differ from other countries throughout the world. The prevalence of occupationally acquired HIV infection is likely to be underreported in developing countries, including India, given the fact that needlestick injuries are common and very few individuals take prophylaxis or get tested for HIV after such exposures. In this report we describe 2 individuals who worked in settings where needlestick injuries were frequent and occurred at a time when use of PEP was infrequent. Although seroconversion was not proven in these cases, the absence of any other identified risk factor suggests that the HIV was occupationally transmitted. This report also serves to highlight the lack of commitment of society to fund the lifelong treatment of these individuals. Readers are encouraged to respond to George Lundberg, MD, Editor of MedGenMed, for the editor's eye only or for possible publication via email: ten.epacsdem@grebdnulg