- 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
- 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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