Seroconversion Rates Among Healthcare Workers Exposed to Human Immunodeficiency Virus and Hepatitis C-Contaminated Body Fluids: The University of Pittsburgh Experience

Background: Human Immunodeficiency Virus (HIV) and hepatitis C virus (HCV) transmission to healthcare personnel (HCP) following percutaneous exposure to the blood of a source patient, has been reported to occur at an average rate of 0.3% (0.2-0.5%) and 1.8% (range 0-10%), respectively. Most of this data are either outdated or were from predominantly non-US centers. We aimed to determine the seroconversion rate after exposure to HIV or HCV-contaminated body fluid in a major academic center in the US. 

Methods: A longitudinal analysis of a prospectively maintained database of reported occupational injuries occurring between 2002 and 2015 at the University of Pittsburgh Medical Center was performed. Inclusion criteria included HCP who sustained needlestick, laceration, and splash injuries from a known HIV or HCV-positive patient. Exclusion criteria included missing data on the type of injury and fluids. Data collected included the type of injury, injured body part, type of fluid, contamination of sharps, involvement of resident physicians, use of post-exposure prophylaxis, and patients’ HCV, HIV and hepatitis B status. Univariate and bivariate statistical analysis was performed using SPSS statistical software (version 19.0; SPSS Inc., Chicago, IL, USA). 

Results: Over the 13-year period, 1,627 cases (HIV=266, HCV=1,361) were included in the study. The majority of cases were caused by percutaneous injuries (HIV=52.6%, HCV=65.0%) as opposed to mucocutaneous injuries (HIV=43.2%, HCV=33.7%); resident physicians comprised 4.9% (HIV) and 7.1% (HCV) of HCP; the majority of injuries occurred in the hand (HIV=52.6%, HCV=63.3%) and were due to blood exposure (HIV=64.3%, HCV=72.7%). Blood exposure accounted for 64.3% (HIV) and 72.7% (HCV) of cases, saliva for 5.6% (HIV) and 3.4% (HCV), and other fluids for 13.6% (HIV) and 11% (HCV). The seroconversion rate was calculated at 0% (N=0) for HIV and 0.1% (n=2) for HCV, caused by blood exposure secondary to percutaneous injuries. 

Conclusion: This study provides the most recent data from a major US academic medical center. The seroconversion rates among HCP exposed to HIV and HCV-contaminated body fluids (0% and 0.1% respectively), were found to be lower than most of the data found in the literature. HIV and HCV do not seem to be easily transmitted by needlestick, laceration, or splash injuries. However, further large-scale studies are needed for a more accurate estimation of the risk of transmission.