HIV transmission at a Saudi Arabia hemodialysis unit.
BACKGROUND
Hemodialysis is associated with increased risk of healthcare-associated infections but considered a low-risk setting for human immunodeficiency virus (HIV) transmission. We investigated 3 hemodialysis unit (HDU) patients with new HIV infections to determine whether transmission was hemodialysis-associated and to correct factors that contributed to transmission.


METHODS
Each patient was evaluated for HIV risk factors. Blood samples were tested to determine relatedness of HIV strains. Clinical data (gathered over 18 months) was reviewed to identify seroconversions at 12 HDUs. Infection prevention and control practices were evaluated at 14 HDUs.


RESULTS
No other HIV seroconversions were identified during the study. HIV gag, pol, and env gene sequences were consistent with a clonal relationship. HIV and hepatitis C virus prevalence rates at one HDU 1 (5.7% and 6.5%, respectively) were higher than for 11 other HDUs (0% and 0.15%, respectively).


CONCLUSIONS
Sequencing supports either patient-to-patient or common-source transmission. Infections occurred despite Saudi Arabia's low HIV prevalence and national dialysis policies that emphasize stringent infection prevention and control practices.
Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Faisal
F
Mashragi
Bureau of Epidemiology, Florida Department of Health, Tallahassee.
Robert S
RS
Bernstein
Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Mohammad
M
Al-Mazroa
Saudi Aramco Medical Services Organization, Dhahran.
Jaffar A
JA
Al-Tawfiq
Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Sanaa
S
Filemban
Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Abdullah
A
Assiri
Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Elaine
E
Furukawa
Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Mohammad
M
Al Hazmi
Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Abdullah
A
Alzahrani
Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Gwen
G
Stephens
Ministry of Health, Riyadh, Kingdom of Saudi Arabia College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.
Ziad A
ZA
Memish
D000328:Adult; D000368:Aged; D003428:Cross Infection; D005260:Female; D005814:Genes, Viral; D019983:Guideline Adherence; D006678:HIV / Q000145:classification / Q000235:genetics; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000635:transmission*; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006757:Hospital Units / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D008875:Middle Aged; D010802:Phylogeny; D062486:Public Health Surveillance; D006435:Renal Dialysis / Q000009:adverse effects*; D012529:Saudi Arabia / Q000453:epidemiology
HCV; HIV; epidemic outbreak; healthcare-associated infections; hemodialysis