Healthcare Workers Exposed to HIV/AIDS

The human immunodeficiency virus (HIV) is a retrovirus that causes acquired immune deficiency syndrome (AIDS). HIV can be transmitted through the exchanging of bodily fluids including blood, semen, vaginal discharge, and breast milk. Means of transmission include sexual contact with an infected person, sharing of needles or syringes with an infected person, or through blood transfusions with infected blood. Low quantities of HIV has been found in the saliva and tears of some AIDS patients; however, contact with saliva or tears has never resulted in an HIV transmission.

Healthcare workers are often exposed to the virus at work; however, it is unlikely that they will contract the virus from a patient. Since December 2001, there have been only 57 documented reports of patient-to-worker HIV transmission, mainly due to precautionary guidelines that healthcare workers follow. The main risk of transmission for healthcare workers  is through accidental needle sticks or other injury with a contaminated instrument. However, even here the risk is small. “Researchers estimate that only about 0.0-1% or healthcare workers” contract HIV from an accidental needle stick.

This low statistic can be attributed to post-exposure prophylaxis (PEP), which can be taken immediately after exposure to reduce the risk of transmission. PEP uses antiretroviral therapy (ART) to prevent transmission, but often comes with serious side effects including dizziness, fatigue, nausea, vomiting, diarrhea and more. Current antiretroviral drugs cannot cure HIV infection, nor reduce the risk of transmitting it to someone else, but they can suppress the virus to undetectable levels in some cases. It has been estimated that PEP reduces the infection rate among healthcare workers by 79%.

Post-exposure Prophylaxis should begin immediately after the exposure, seeing as how PEP is most effective when it is initiated within two t0 four hours of exposure. The specific dosage of medication depends on a couple factors including the patient’s overall health, the severity of exposure, the availability of antiretrovirals, and if the patient has any known or possible cross-resistance to any drugs. Treatment normally lasts no less than two weeks and no longer than four. Studies show that almost a quarter of those receiving PEP stop taking the medications early because of side effects. As with all forms of treatment, it is less effective if it ends early.

HIV tests should be performed after any risky sexual behavior, even if PEP was used. Immediately after HIV enters the body antibodies are produced to fight off the infection. While these antibodies cannot completely eliminate the virus, we can use their presence to see if HIV is in the blood. Most people develop detectable antibodies within two to eight weeks; however, it may take longer in some people. Most often, the enzyme immunoassay (EIA) test is used to detect HIV antibodies. If a positive result is returned it is confirmed with a follow-up test before making a diagnosis. Typically the Western blot test is used to confirm a positive HIV result. Other testing options include DNA or RNA tests, which instead of looking for antibodies actually look for genetic material of HIV. These tests can be used for early detection of HIV.

With the combination of healthcare precautions and treatment options such as PEP, we have the ability to decrease the number of patient to worker HIV transmissions drastically.

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