Occupational exposure to human immunodeficiency virus and hepatitis B virus: a comparative analysis of risk.
OBJECTIVE
To estimate the occupational risk from infection with the human immunodeficiency virus (HIV) in terms of loss of (quality-adjusted) life expectancy, and to compare that risk to those posed by other hazards faced by health care workers.


METHODS
Decision-analytic model.


RESULTS
For a 30-year-old female health care worker (unvaccinated for hepatitis B virus [HBV]), the loss of life expectancy from a needlestick from a symptomatic HIV-positive (HIV+) patient is 39 days (range, 17 to 93 days), as compared with a loss of 17 days from a needlestick from a patient who is hepatitis-B-surface-antigen-positive (HBsAg+), and 38 days from a needlestick from a patient who is hepatitis-B-e-antigen-positive (HBeAg+). When morbidity is included in the analysis of risk (through calculation of the quality-adjusted loss of life expectancy), the risk from both HBV and HIV increases. The quality-adjusted loss of life expectancy due to a needlestick exposure from a symptomatic HIV+ patient is 45 days (range, 20 to 108 days), as compared with a quality-adjusted loss of life expectancy of 48 days from a needlestick from an HBsAg+ patient, and 109 days from a needlestick from a patient who is known to be HBeAg+. By comparison, a cross-country automobile trip is associated with a loss of life expectancy of approximately 1 day. The 45- to 50-day loss of quality-adjusted life expectancy from percutaneous exposures to HIV and HBV is approximately the same magnitude as the gain in life expectancy from 10 years of annual screening for breast cancer with mammography and physical examination.


CONCLUSIONS
The risk associated with percutaneous exposures to symptomatic HIV+ patients is comparable to other risks that health care workers have faced knowingly and have accepted in the recent past. However, the loss of quality-adjusted life expectancy associated with a needlestick exposure is significant. Identification of cost-effective methods that increase the safety of medical personnel but also ensure full access to high-quality care for HIV+ patients should be a high priority.
Owens
D K
DK
Department of Veterans Affairs Medical Center, Palo Alto, CA.
Nease
R F
RF
D000163:Acquired Immunodeficiency Syndrome / Q000635:transmission*; D000328:Adult; D002140:California; D005260:Female; D006678:HIV; D006282:Health Personnel; D006509:Hepatitis B / Q000635:transmission*; D006515:Hepatitis B virus; D006785:Hospitals, University; D006801:Humans; D008017:Life Expectancy; D015233:Models, Statistical; D016602:Needlestick Injuries / Q000150:complications; D009784:Occupational Diseases / Q000209:etiology; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D011336:Probability; D012307:Risk Factors; D013997:Time Factors