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OCCUPATIONAL
TRANSMISSION OF HIV AND HEPATITIS C VIRUS AFTER A PUNCH
Awareness of the risk of
occupational transmission of HIV to health care
workers dates back to December 1984, when the first case of
needlestick-transmitted HIV infection was reported [1]. From December
1984
through September 1997, a total of 94 documented cases and 170 possible
cases of occupational transmission of HIV to health care workers were
reported worldwide. However, individuals with other types of jobs also
risk
occupational exposure to bloodborne infection. We report the case of a
policeman in whom both HIV and hepatitis C virus (Hepatitis C Virus) seroconversion
were
clearly documented after he was involved in a bloody fight while making
an
arrest.
A 52-year-old policeman
(patient A) presented with a positive HIV
result on EIA. Ten weeks previously, he had developed an acute
mononucleosis-like syndrome. Acute HIV-1 infection was confirmed by
means
of gradual Western blot positivity. His CD4+ lymphocyte count was 399
Ã109
cells/L, and his plasma level of HIV type 1 (HIV-1) RNA was 503,200
copies/mL. Alanine aminotransferase activity was slightly elevated. No
antibodies to Hepatitis C Virus were detected, and the patient was immune to hepatitis
B
virus (HBV). Three weeks later, Hepatitis C Virus seroconversion was diagnosed (by
means
of EIA, recombinant immunoblot assay, and plasma Hepatitis C Virus RNA positivity).
The
patient's sex partner was seronegative for both viruses, and the patient
denied having had another sex partner during the previous 6 months. He
had
never received blood transfusions and had never been an injection drug
user. However, he disclosed that, 3 weeks before the onset of his
illness,
he had punched a man in the teeth while making an arrest. Although he
had
noticed 2 wounds on his hand, which was covered with blood, he did not
wash
his hand immediately after the incident. Within a few days after the
arrest, he developed lymphangitis that required antibiotic treatment.
The man who received the
punch (patient B) was known to be infected
with HIV-1, human T lymphotropic virus type 1 (HTLV-1), HBV, and Hepatitis C Virus,
but
patient B declined all treatment. Six months after the incident, patient
B's CD4+ lymphocyte count was 552 Ã109 cells/L, his plasma level of
HIV-1
RNA was 52,900 copies/mL, and his plasma level of Hepatitis C Virus RNA (Amplicor Hepatitis C Virus
Monitor; Roche Diagnostics, Branchburg, NJ) was 132,052 copies/mL.
The strains of HIV and
Hepatitis C Virus that infected the 2 patients were
compared. Viruses were isolated from the plasma of patient A at 4 months
after the incident and from patient B at 6 months after the incident.
Both
Hepatitis C Virus strains were determined to be genotype 2a. Nucleotide sequencing of
the
amplification product of the V3 region of HIV and the NS5b region of Hepatitis C Virus
revealed, respectively, 98.7% and 100% identity for the strains
infecting
the 2 patients. Fifteen months after the fight, the serological results
of
HTLV-1 testing were still negative.
Simultaneous
transmission of either HIV and Hepatitis C Virus or HIV and HBV from a
single source has been previously described [2, 3]; however, to our
knowledge, this is the first proven case of HIV-Hepatitis C Virus coinfection that
occurred as the result of a blow with the fist. Although HIV is probably
infrequently transmitted via this route, this case raises the question
of
whether prophylaxis should be used after potential exposure to HIV
during a
bloody fight with an HIV-infected (or possibly HIV-infected) individual,
as
is recommended after other types of potential exposure to HIV,
especially
among individuals with frequent occupational exposure to HIV (e.g.,
police
and fire department employees, etc.) [4]. Similarly, the risk of
transmission of Hepatitis C Virus infection during violent incidents should be taken
into
account.
References
1. Ippolito G, Puro V,
Heptonstall J, Jagger J, De Carli G, Petrosillo N.
Occupational human immunodeficiency virus infection in health care
workers:
worldwide cases through September 1997. Clin Infect Dis 1999;
28:365[]83.
First citation in article | PubMed
2. Ridson R, Gallagher K, Ciesielski C, et al. Simultaneous transmission
of human immunodeficiency virus and hepatitis C virus from a
needle-stick
injury. N Engl J Med 1997; 336:919[]22. First citation in article |
PubMed
3. Brambilla A, Pristera R, Salvatori F, Poli G, Vicensi E. Transmission
of HIV-1 and Hepatitis C Virus by head-butting. Lancet 1997; 350:1370. First citation
in
article | PubMed
4. Lurie P, Miller S, Hecht F, Chesney M, Lo B. Postexposure prophylaxis
after nonoccupational HIV exposure. JAMA 1998; 280:1769[]73. First
citation
in article | PubMed
Source of Article: Center for Information and Care on Human
Immunodeficiency
http://www.journals.uchicago.edu/
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