Risk of AIDS to health care workers.

This article reviews evidence on the risk of acquired immunodeficiency syndrome (AIDS) to health workers and suggests guidelines for the clinical care of AIDS patients. No health worker in the world has yet contracted AIDS from a patient. However seroconversion to human T-lymphotropic virus type III (HTLV-III) has occurred in a small number. A serologic study of 1758 US health workers who had direct contact with AIDS patients found HTLV-III antibodies in the blood of 26 (1.5%) but 23 of these workers were in another high-risk group for AIDS (homosexual men). Similar studies in San Francisco and London that included large numbers of health workers who sustained needlestick injuries while working with AIDS patients have failed to detect seroconversion. A further study of the siblings children and parents of 39 adult AIDS victims also found no evidence of infection suggesting that AIDS does not occur by casual contact. HTLV-III appears to be less communicable than the hepatitis B virus which health service staff have contracted from infected blood. It is recommended that when a patient known to be positive for HTLV-III is admitted to the hospital all specimens from that patient should be labelled with a biohazard sticker. Specimens should be handled and processed in the same way as those from hepatitis B patients. Staff should wear gloves and a plastic apron when attending to these patients. Although isolation is not necessary it is unwise to place patients with HTLV-III in the same ward with patients who are immunocompromised for other reasons given the risk of 2-way transmission of infection. Finally every effort should be made to maintain confidentiality and lists of HTLV-III-positive patients should not be displayed.