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Posted on
6/24/00 11:05 PM

HIV Seroconversion in HCWs (Health Care Workers)

Data on the timing and clinical characteristics of seroconversion in HIV-exposed HCWs are
limited by the infrequency of infection following occupational exposure, variations in
postexposure testing intervals, and differences over time in the sensitivity of HIV-antibody testing
methods. Among the HCWs with documented seroconversions reported to CDC for whom
data are available, 81% experienced a syndrome compatible with primary HIV infection a
median of 25 days after exposure (CDC, unpublished data, 1998). In a recent analysis of 51
seroconversions in HCWs, the estimated median interval from exposure to seroconversion was
46 days (mean: 65 days); an estimated 95% seroconverted within 6 months after the exposure
(34). These data suggest that the time course of HIV seroconversion in HCWs is similar to that
in other persons who have acquired HIV through nonoccupational modes of transmission (35).

Three instances of delayed HIV seroconversion occurring in HCWs have been reported; in
these instances, the HCWs tested negative for HIV antibodies greater than 6 months
postexposure but were seropositive within 12 months after the exposure (36,37; J.L.
Gerberding, San Francisco General Hospital, unpublished data, May 1997). DNA sequencing
confirmed the source of infection in one instance. Two of the delayed seroconversions were
associated with simultaneous exposure to hepatitis C virus (HCV) (37; J.L. Gerberding, San
Francisco General Hospital, unpublished data, May 1997). In one case, co-infection was
associated with a rapidly fatal HCV disease course (37); however, it is not known whether
HCV directly influences the risk for or course of HIV infection or is a marker for other
exposure-related factors.

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