Occupational risk of the acquired immunodeficiency syndrome among health care workers.

In August 1983, we initiated nationwide prospective surveillance of health care workers with documented parenteral or mucous-membrane exposures to blood or other body fluids of patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related illnesses. The purpose of the surveillance project is to quantitate prospectively the risk to health care workers of acquiring the AIDS virus, human T-cell lymphotropic virus Type III/lymphadenopathy-associated virus (HTLV-III/LAV), as a result of occupational exposures. By December 31, 1985, 938 health care workers were being followed in the surveillance project. The mean length of follow-up was 15 months (range, 0 to 56) and 531 health care workers (57 percent) had been followed for more than one year. Needlestick injuries and cuts with sharp instruments accounted for 76 percent of the exposures. Over 85 percent of all exposures were to blood or serum. None of the health care workers have acquired signs or symptoms of AIDS. Analyses of T-lymphocyte subsets were performed for 341 (36 percent) of the exposed health care workers, and tests for antibody to HTLV-III/LAV were performed for 451 (48 percent). Seven health care workers who had low helper/suppressor T-lymphocyte ratios on initial testing were retested; only three had persistently low ratios. Only two health care workers tested were seropositive for antibody to HTLV-III/LAV. The results of this surveillance project, thus far, suggest that the risk to health care workers of occupational transmission of HTLV-III/LAV is low (the upper bound of the 95 percent confidence interval for the seroprevalence rate among workers with greater than or equal to 3 months of follow-up with HTLV-III/LAV antibody testing is 1.65 percent) and appears to be related to parenteral exposure to blood.