AIDS-Infected Nurse
Transmits HIV To Patient
By Penny Stern, MD
NEW YORK (Reuters Health) -- Concerns about the transmission of human immunodeficiency virus (HIV) have never been far from the public's awareness since the disease was recognized nearly two decades ago. Now, from a joint French-Belgian research group comes a report about an unusual case where it appears the virus was transmitted from a nurse to a patient recovering from surgery.
Writing in the Journal of Virology, Dr. Michel Milinkovitch of the Free University of Brussels and colleagues in France describe the circumstances surrounding the case of a female surgical patient in suburban Paris who developed puzzling signs of HIV infection several months after an apparently uneventful hospital stay.
The researchers noted that the patient had no known risk factors for HIV. But during the woman's initial hospital stay, the investigators learned that she received care from two night nurses who were HIV positive. A sophisticated analysis of the virus obtained through blood samples taken from the nurses and the patient revealed that one of the nurses was the likely source of the infection.
``The results... unambiguously exclude one (HIV-positive) nurse, but strongly suggest another (HIV-positive) nurse as the source of transmission of (HIV) to the patient,'' the study authors explain. The nurse implicated was apparently unaware of her HIV status until a month before the patient returned to the hospital with HIV symptoms. The other nurse was aware of his HIV-positive status.
According to Milinkovitch, the complex protein and DNA analysis performed in the study, ``is very powerful for answering a surprisingly large number of biological questions,'' he told Reuters Health.
In this case, the testing showed that segments from the patient's strain of HIV and the nurse's, were related. Though it was theoretically possible for the nurse to have been infected by the patient, the nurse in question already had indications of advanced infection by the time the virus was found in the patient's blood.
It is not clear how the nurse may have transmitted the virus to the patient. But the case demonstrates, Milinkovitch added, that ``HIV could be transmitted during medical practice even in the absence of invasive procedures.'' That is, even though the patient did not require procedures such as blood transfusions during her initial hospital stay.
However, Milinkovitch believes that ``the risks of transmission from a patient to a healthcare worker far exceed that of transmission from the healthcare worker to the patient'' for several reasons. These include the fact that a healthcare worker is in contact with a high number of patients (who are all potential sources of infection) while the patient is in contact with relatively few healthcare workers, and that many patients may have open wounds or other conditions ``favoring the transfer of virus to healthcare workers.''
He points out to Reuters Health that ``since AIDS has become a major disease, many pathologies are associated with it and a higher-than-average proportion of people consulting healthcare workers -- in comparison with the rest of the population -- might be HIV positive.'' Therefore, it is the workers and not the patient who appear to be at greater risk for exposure in the hospital setting.
But Milinkovitch adds that ``the risk of being infected during healthcare practice is exceedingly lower than the risk of being infected (in activities unrelated to healthcare).''
Because healthcare workers are aware of the risks of transmissible diseases, they generally follow the established safety guidelines carefully. Milinkovitch believes, therefore, that ``because healthcare workers protect themselves, they automatically protect their patients.''
The researchers call the case ``exceptional,'' but say that it ``indicates nonetheless that safety guidelines established for reducing risks of blood-borne transmission of (infectious agents) between healthcare workers and patients should be carefully followed.'' SOURCE: Journal of Virology 2000;74:2525-2532.

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