Login Register Cart 0
Generic placeholder image

Current HIV Research

Editor-in-Chief

ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Letter Article

Clinical Outcomes of Post-exposure Prophylaxis following Occupational Exposure to Human Immunodeficiency Virus at Dental Departments of Hiroshima University Hospital

Author(s): T. Shintani*, T. Iwata, M. Okada, M. Nakaoka, N. Yamasaki, T. Fujii and H. Shiba

Volume 18, Issue 6, 2020

Page: [475 - 479] Pages: 5

DOI: 10.2174/1570162X18666200804151118

open access plus

Abstract

Background: Dental professionals have so many opportunities to use injection needles and sharp instruments during dental treatment that they face an increased risk of needlestick injuries. This retrospective study reports the utilization and clinical outcomes of occupational post-exposure prophylaxis (PEP) with anti-retroviral agents after being potentially exposed to HIV at the dental departments of Hiroshima University Hospital.

Objective: This study reports the utilization and clinical outcomes of occupational post-exposure prophylaxis (PEP) with antiretroviral agents after being potentially exposed to HIV at dental departments of Hiroshima University Hospital.

Methods: Data on the clinical status of HIV-infected source patients and information on HIV-exposed dental professionals from 2007 to 2018 were collected.

Results: Five dentists with an average experience of 5.6 years (1-15 years) were exposed. The averaged CD4-positive cell number and HIV-RNA load were 1176 (768-1898) /μl and less than 20 copies/ml, respectively, in all the patients. Two of the five HIV exposed dentists received PEP. Three months after the exposures, all of their results were negative in HIV antibody/antigen tests.

Conclusion: ; These data might support the concept of “undetectable equals untransmittable”, although HIV exposure in this study was not through sexual transmission.

Keywords: HIV, U=U, occupational exposures, post-exposure prophylaxis, needlestick injury, dental treatment.

« Previous Next »
Graphical Abstract

[1]
Morinaga K, Hagita K, Yakushiji T, Ohata H, Sueishi K, Inoue T. Analysis of needlestick and similar injuries over 10 years from April 2004 at Tokyo Dental College Chiba Hospital. Bull Tokyo Dent Coll 2016; 57(4): 299-305.
[http://dx.doi.org/10.2209/tdcpublication.2015-0036] [PMID: 28049978]
[2]
Porter K, Scully C, Theyer Y, Porter S. Occupational injuries to dental personnel. J Dent 1990; 18(5): 258-62.
[http://dx.doi.org/10.1016/0300-5712(90)90025-A] [PMID: 2074298]
[3]
deVries B, Cossart YE. Needlestick injury in medical students. Med J Aust 1994; 160(7): 398-400.
[http://dx.doi.org/10.5694/j.1326-5377.1994.tb138262.x] [PMID: 8007860]
[4]
Chowanadisai S, Kukiattrakoon B, Yapong B, Kedjarune U, Leggat PA. Occupational health problems of dentists in southern Thailand. Int Dent J 2000; 50(1): 36-40.
[http://dx.doi.org/10.1111/j.1875-595X.2000.tb00544.x] [PMID: 10945178]
[5]
Schmid K, Schwager C, Drexler H. Needlestick injuries and other occupational exposures to body fluids amongst employees and medical students of a German university: incidence and follow-up. J Hosp Infect 2007; 65(2): 124-30.
[http://dx.doi.org/10.1016/j.jhin.2006.10.002] [PMID: 17174445]
[6]
Stewardson DA, Palenik CJ, McHugh ES, Burke FJ. Occupational exposures occurring in students in a UK dental school. Eur J Dent Educ 2002; 6(3): 104-13.
[http://dx.doi.org/10.1034/j.1600-0579.2002.00253.x] [PMID: 12269865]
[7]
Wicker S, Rabenau HF. Occupational exposures to bloodborne viruses among German dental professionals and students in a clinical setting. Int Arch Occup Environ Health 2010; 83(1): 77-83.
[http://dx.doi.org/10.1007/s00420-009-0452-3] [PMID: 19626335]
[8]
McDonald RI, Walsh LJ, Savage NW. Analysis of workplace injuries in a dental school environment. Aust Dent J 1997; 42(2): 109-13.
[http://dx.doi.org/10.1111/j.1834-7819.1997.tb00105.x] [PMID: 9153838]
[9]
Patterson JM, Novak CB, Mackinnon SE, Ellis RA. Needlestick injuries among medical students. Am J Infect Control 2003; 31(4): 226-30.
[http://dx.doi.org/10.1067/mic.2003.44] [PMID: 12806360]
[10]
Leggat PA, Smith DR. Prevalence of percutaneous exposure incidents amongst dentists in Queensland. Aust Dent J 2006; 51(2): 158-61.
[http://dx.doi.org/10.1111/j.1834-7819.2006.tb00420.x] [PMID: 16848264]
[11]
Kobayashi K. Questionnaire study of needlestick injuries and hepatitis B vaccination in general dental practices. Jpn J Infec Prev Cont 2015; 30(5): 348-53.
[http://dx.doi.org/10.4058/jsei.30.348]
[12]
Hirose A, Ozawa R, Ishizu E, et al. Investigation of needle sticks and incisions by medical workers in dental clinics. Jpn J Dent Prac Admin 2009; 43(4): 264-74.
[13]
Yoneda M, Izumi T, Suzuki N, et al. Analysis of needlestick injuries in Fukuoka Dental College Medical and Dental Hospital. Jpn J Conserv Dent 2009; 52(2): 168-75.
[14]
Bell DM. Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am J Med 1997; 102(5B): 9-15.
[http://dx.doi.org/10.1016/S0002-9343(97)89441-7] [PMID: 9845490]
[15]
Public Health Service guidelines for the management of health- care worker exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 1998; 47(RR-7): 1-33.
[PMID: 9603630]
[16]
Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001; 50(RR-11): 1-52.
[PMID: 11442229]
[17]
Ippolito G, Puro V, De Carli G. The risk of occupational human immunodeficiency virus infection in health care workers. Italian Multicenter Study. The Italian Study Group on Occupational Risk of HIV infection. Arch Intern Med 1993; 153(12): 1451-8.
[http://dx.doi.org/10.1001/archinte.1993.00410120035005] [PMID: 8512436]
[18]
Risk of sexual transmission of HIV from a person living with HIV who has an undetectable viral load https://www.preventionaccess.org/undetectable2016.
[19]
Calabrese SK, Mayer KH. Providers should discuss U=U with all patients living with HIV. Lancet HIV 2019; 6(4): e211-3.
[http://dx.doi.org/10.1016/S2352-3018(19)30030-X] [PMID: 30772420]
[20]
Rendina HJ, Parsons JT. Factors associated with perceived accuracy of the Undetectable = Untransmittable slogan among men who have sex with men: Implications for messaging scale-up and implementation. J Int AIDS Soc 2018; 21(1): e25055.
[http://dx.doi.org/10.1002/jia2.25055] [PMID: 29334178]
[21]
Vernazza P, Hirschel B, Bernasconi E, Flepp M. Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuelle http://i-base.info/qa/wp-content/uploads/2008/02/Swiss-Commission-statement_May-2008_translation-EN.pdf2015.
[22]
Rodger AJ, Cambiano V, Bruun T, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 2019; 393(10189): 2428-38.
[http://dx.doi.org/10.1016/S0140-6736(19)30418-0] [PMID: 31056293]
[23]
Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA 2016; 316(2): 171-81.
[http://dx.doi.org/10.1001/jama.2016.5148] [PMID: 27404185]
[24]
Bavinton BR, Pinto AN, Phanuphak N, et al. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet HIV 2018; 5(8): e438-47.
[http://dx.doi.org/10.1016/S2352-3018(18)30132-2] [PMID: 30025681]
[25]
Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 2011; 365(6): 493-505.
[http://dx.doi.org/10.1056/NEJMoa1105243] [PMID: 21767103]
[26]
Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. N Engl J Med 2000; 342(13): 921-9.
[http://dx.doi.org/10.1056/NEJM200003303421303] [PMID: 10738050]
[27]
Attia S, Egger M, Müller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS 2009; 23(11): 1397-404.
[http://dx.doi.org/10.1097/QAD.0b013e32832b7dca] [PMID: 19381076]
[28]
Beekmann SE, Henderson DK. Prevention of HIV/AIDS: Post-Exposure Prophylaxis (including Healthcare Workers). Infect Dis Clin North Am 2014; 28(4): 601-13.
[http://dx.doi.org/10.1016/j.idc.2014.08.005] [PMID: 25287589]
[29]
Elliott T, Sanders EJ, Doherty M, et al. Challenges of HIV diagnosis and management in the context of pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), test and start and acute HIV infection: a scoping review. J Int AIDS Soc 2019; 22(12): e25419.
[http://dx.doi.org/10.1002/jia2.25419] [PMID: 31850686]
[30]
Thomas R, Galanakis C, Vézina S, et al. Adherence to Post-Exposure Prophylaxis (PEP) and incidence of HIV seroconversion in a major North American Cohort. PLoS One 2015; 10(11): e0142534.
[http://dx.doi.org/10.1371/journal.pone.0142534] [PMID: 26559816]
[31]
Ford N, Irvine C, Shubber Z, et al. Adherence to HIV postexposure prophylaxis: a systematic review and meta-analysis. AIDS 2014; 28(18): 2721-7.
[http://dx.doi.org/10.1097/QAD.0000000000000505] [PMID: 25493598]
[32]
Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med 1997; 337(21): 1485-90.
[http://dx.doi.org/10.1056/NEJM199711203372101] [PMID: 9366579]
[33]
Shih CC, Kaneshima H, Rabin L, et al. Postexposure prophylaxis with zidovudine suppresses human immunodeficiency virus type 1 infection in SCID-hu mice in a time-dependent manner. J Infect Dis 1991; 163(3): 625-7.
[http://dx.doi.org/10.1093/infdis/163.3.625] [PMID: 1995734]
[34]
Tsai CC, Emau P, Follis KE, et al. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol 1998; 72(5): 4265-73.
[http://dx.doi.org/10.1128/JVI.72.5.4265-4273.1998] [PMID: 9557716]
[35]
Kuhar DT, Henderson DK, Struble KA, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol 2013; 34(9): 875-92.
[http://dx.doi.org/10.1086/672271] [PMID: 23917901]
[36]
Deguchi M, Yoshioka N, Kagita M, et al. Evaluation of human immunodeficiency virus-1/2 antigen/antibody immunochromatographic assay. Clin Lab 2012; 58(11-12): 1193-201.
[PMID: 23289189]
[37]
Sekiguchi H, Ayabe A, Ohta A, Ishibashi M. Evaluation of the 4th generation HIV rapid diagnostic kit ‘ESPLINE HIV Ag/Ab’. Jpn J Med Pharm Sci 2010; 63(4): 673-80.
[38]
Kawahata T, Nagashima M, Sadamasu K, Kojima Y, Mori H. [Evaluation of an immunochromatographic fourth generation test for the rapid diagnosis of acute HIV infection]. Kansenshogaku Zasshi 2013; 87(4): 431-4.
[http://dx.doi.org/10.11150/kansenshogakuzasshi.87.431] [PMID: 23984592]
[39]
Faraoni S, Rocchetti A, Gotta F, et al. Evaluation of a rapid antigen and antibody combination test in acute HIV infection. J Clin Virol 2013; 57(1): 84-7.
[http://dx.doi.org/10.1016/j.jcv.2013.01.007] [PMID: 23380659]
[40]
Brauer M, De Villiers JC, Mayaphi SH. Evaluation of the Determine™ fourth generation HIV rapid assay. J Virol Methods 2013; 189(1): 180-3.
[http://dx.doi.org/10.1016/j.jviromet.2013.01.017] [PMID: 23391823]
[41]
Waitt C, Low N, Van de Perre P, Lyons F, Loutfy M, Aebi-Popp K. Does U=U for breastfeeding mothers and infants? Breastfeeding by mothers on effective treatment for HIV infection in high-income settings. Lancet HIV 2018; 5(9): e531-6.
[http://dx.doi.org/10.1016/S2352-3018(18)30098-5] [PMID: 29960731]
[42]
U=U taking off in 2017. Lancet HIV 2017; 4(11): e475.
[http://dx.doi.org/10.1016/S2352-3018(17)30183-2] [PMID: 29096785]
[43]
Leylabadlo HE, Baghi HB, Fallahi L, Kafil HS. From sharing needles to unprotected sex: a new wave of HIV infections in Iran? Lancet HIV 2016; 3(10): e461-2.
[http://dx.doi.org/10.1016/S2352-3018(16)30158-8] [PMID: 27687040]
[44]
Klein RS, Phelan JA, Freeman K, et al. Low occupational risk of human immunodeficiency virus infection among dental professionals. N Engl J Med 1988; 318(2): 86-90.
[http://dx.doi.org/10.1056/NEJM198801143180205] [PMID: 3422106]
[45]
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(2): 365-83.
[http://dx.doi.org/10.1086/515101] [PMID: 10064256]
[46]
Joyce MP, Kuhar D, Brooks JT. Notes from the field: occupationally acquired HIV infection among health care workers - United States, 1985-2013. MMWR Morb Mortal Wkly Rep 2015; 63(53): 1245-6. [MMWR].
[PMID: 25577991]
[47]
Tomkins S, Ncube F. Occupationally acquired HIV: international reports to December 2002. Eurosurveillance Weekly 2005; 10(10)
[48]
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/275060/EAGA_advice_on_PEP_after_exposure_to_UD_source_Dec13.pdf2013.
[49]
Puro V, Cicalini S, De Carli G, et al. Post-exposure prophylaxis of HIV infection in healthcare workers: recommendations for the European setting. Eur J Epidemiol 2004; 19(6): 577-84.
[http://dx.doi.org/10.1023/B:EJEP.0000032349.57057.8a] [PMID: 15330131]
[50]
HIV Post-exposure prophylaxis: Guidance from the UK Chief Medical Officers’ Expert Advisory Group on AIDS. Department of Health 2008.

Rights & Permissions Print Cite
Article Metrics
43
2
World Immunization Week
© 2024 Bentham Science Publishers | Privacy Policy