"Hepatitis C Virus and HIV Coinfection after Conjunctival Contamination with
Blood." G. Ippolito, G. De Carli, V. Puro, N. Petrosillo, M.
Rastrelli, G. Micheloni and L. Caggese. Coordinating Centre of the
Italian Study on Occupational Risk of HIV infection (SIROH) at
Centro di Riferimento AIDS IRCCS 'L. Spallanzani', Roma, Italy.
According to an abstract submitted by the authors to the 48th
Annual Meeting of the American Association for the Study of Liver
Diseases, held November 7-11, 1997 in Chicago, Illinois, "In the
SIROH we previously observed a nurse who acquired HIV infection
and developed acute nonA, nonB hepatitis (assays for anti-Hepatitis C Virus
antibodies were at that time not available) via mucous membrane
blood contamination. The nurse progressed to AIDS four years after
and died within five years. More recently, another case of
documented occupational HIV and Hepatitis C Virus simultaneous infection
following blood contamination of conjunctive was observed in a
housekeeper when disposing of open, HIV infected blood tubes.
Zidovudine prophylaxis was administered three hours after exposure
at 1000 mg/die for four weeks. Baseline anti-HIV and anti-Hepatitis C Virus
tests were negative. An acute retroviral syndrome developed on day
29 post-exposure. Anti-HIV and anti-Hepatitis C Virus seroconversions were
observed on day 53 and three months post-exposure, respectively.
At four years of seroconversion, CD4(+) cells were 31/mmc, and the
HCW developed full blown AIDS. Simultaneous HIV and Hepatitis C Virus infections
can occur via conjunctival contamination with blood. This route of
exposure should be considered at high risk for occupational
transmission of bloodborne infections. Changes in work procedures
and safety design of items should be implemented to minimize the
risk of occupational exposure due to disposal of blood samples and
to unprotected gaps of personal protective equipment. One-drug
regimen with zidovudine should no longer be considered as
antiretroviral postexposure prophylaxis. It could be postulated
that the pathogenetic interactions between the two viruses during
acute co-infection, that warrant further study, could have led to
a rapid HIV disease progression. Supported by Italian Ministry of
Health -- AIDS project."