HIV AND HEALTH CARE WORKERS

HIV AND HEALTH CARE WORKERS

Health care workers are sometimes said to be at particular risk of getting HIV, either from sprays or spillage of infected blood, or injuries from needles. In fact, the standard infection control measures ("universal precautions") designed to protect against hepatitis B in health care settings will also protect against HIV transmission. Hepatitis B and HIV have similar modes of transmission with one key difference: HIV is much less infectious than hepatitis B.

Though many thousands of patients with HIV have been cared for in hospitals and clinics around the world, only a handful of health care workers have become infected. Where this has happened it has generally been because the standard safety procedures were not followed. These procedures are:

• wear gloves when mopping up body fluids and giving injections
• wear goggles if blood may spurt during surgery
• point needles away from your body
• do not resheath needles after use
• do not leave needles lying around
• dispose of used needles carefully in sharps containers and incinerate them

It is sometimes suggested that health care workers with HIV might be a risk to their patients. Extensive follow up of patients cared for by workers with HIV has revealed only one case in the world of a worker whose patients may have been infected. This was an American dentist, and it remains unclear whether he did actually infect his patients and, if he did, how this happened.



Reducing the risk of transmission during and after pregnancy

A woman living with HIV who wishes to become pregnant may have particular anxieties about the health of her baby. The chance of the virus being transmitted to the baby is about one in seven. It can happen before or during birth or through breast feeding. In parts of the world with lower standards of general health, transmission from a woman with HIV to her baby is more likely.



Viral load and mother-to-baby transmission before and during birth

Viral load is the amount of HIV in the blood. If a woman with HIV has low viral load it is less likely that the virus will be passed to her baby than if she has high viral load. However, even if viral load is very low, there is still a chance that HIV will be transmitted.

Among people with HIV who have not had anti-HIV treatments, viral load is highest during the weeks immediately after infection and when they start to become ill. So a woman with HIV might reduce the risk to her baby by becoming pregnant while she is healthy rather than delaying until she has become ill.

Viral load can often be reduced by taking anti-HIV drugs. Research has shown that if the anti-HIV drug AZT is taken by the mother during the last six months of her pregnancy and while giving birth, and given to the baby for a few weeks after birth, the baby's chances of infection will be reduced by up to two thirds. No significant side effects of exposing babies to AZT before and after birth have yet been reported, but the long-term effects are not known. Taking the drug in this way may also affect the mother's own future treatment options.