Hostname: page-component-cc8bf7c57-77pjf Total loading time: 0 Render date: 2024-12-12T01:48:50.776Z Has data issue: false hasContentIssue false
  • English
  • Français

HIV Screening: Nosocomial Epidemiologic Risks and Decision Analysis

Published online by Cambridge University Press:  29 April 2021

Stephen G. Pauker
Get access Rights & Permissions [Opens in a new window]

Extract

Acquired immunodeficiency syndrome continues to expand exponentially, although the rate of growth in some sectors of the population has been slowing. Unfortunately, these clinically manifest cases constitute only a tiny fraction of the population infected with the human immunodeficiency virus. Epidemiologic data provide only crude estimates of the prevalence of asymptomatic viral infection, although more specific information is available for certain groups, most often defined by demographic, behavioral and medical information. Those data suggest that the prevalence of virus varies some 5000-fold from as low as 0.01 percent up to 50 percent.

The extraordinary and relatively unmodifiable consequences of HIV infection provoke increasing concern among health care workers about the possibility of nosocomial infection. For nosocomial transmission to occur: 1) the patient must be infected; 2) parenteral exposure to blood or certain other body fluids must occur; and 3) the virus must be transferred (with the latter likelihood being proportional to the quantity of exposure).

Type
Article
Information
Law, Medicine and Healthcare , Volume 18 , Issue 1-2 , Summer 1990 , pp. 33 - 40
Copyright
Copyright © 1990 American Society of Law, Medicine & Ethics

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Curran, J.W., Jaffe, H.W., Hardy, A.M., et al., “Epidemiology of HIV infection and AIDS in the United States.” Science 1988; 239:610–616; Heyward, W.L. and Curran, J.W.: “The epidemiology of AIDS in the U.S.,” Scientific American 25:72–81, 1988; Hahn, R.A., Onorato, I.M., Jones, S., Dougherty, J.: “Prevalence of HIV infection among intravenous drug users in the United States.” JAMA 1989; 261:2677–2684.Google Scholar
Institute of Medicine, National Academy of Sciences: Confronting AIDS. National Academy Press (Washington), 1986, Update 1988.Google Scholar
Fineberg, H.V.: “Education to prevent AIDS: Prospects and obstacles.” Science 1988;239:592–596; Becker, M.H., Joseph, J.G.: “AIDS and behavior change to reduce risk.” Am Jour Public Health 1988; 78:394–410.CrossRefGoogle Scholar
Supra note 1.Google Scholar
Handsfield, H.H., Cummings, M.J., Swenson, P.D.: “Prevalence of antibody to human immunodeficiency virus and hepatitis B surface antigen in blood samples submitted to a hospital laboratory.” JAMA 1987;258:3395–3397; “Update: Human immunodeficiency virus infections in health-care workers exposed to blood of infected patients.” MMWR 1987; 36:285–289; McCray, E.: “Occupational risk of acquired immunodeficiency syndome among health care workers.” NEJM 1986; 314:1127–1132; Hirsch, M.S., Wormser, G.P., Schooley, R.T., et al: “Risk of nosocomial infection with human T-cell lymphotrophic virus III (HTLV-III)”: NEJM 1985;312:1–4; Henderson, D.K., Saah, A.J., Zak, B.J., Kaslow, R.A., et al: “Risk of nosocomial infection with human T-cell lymphotrophic virus type III/lymphadenopathy-associated virus in a large cohort of intensively exposed health care workers.” Ann Int Med: 1986; 104:644–647; Weiss, S.H., Saxinger, W.C., Rechtman, D., et al: “HTLV-III infection among health care workers: Association with needle-stick injuries.” JAMA 1985; 254:2089–2093; Geberding, J.L., Bryant-LeBlanc, C.E., Nelson, K., et al: “Risk of transmitting the human immunodeficiency virus, cytomegalovirus, and hepatitis B virus to health care workers exposed to patients with AIDS and AIDS-related conditions.” J. Infect Dis 1987; 156:1–8; McEvoy, M., Porter, K., Mortimer, P., et al: “Prospective study of clinical, laboratory and ancillary staff with accidental exposures to blood or body fluids from patients infected with HIV.” Brit Med J 1987; 294:1595–1597; Kuhls, T.L., Viker, S., Parris, N.B., Garakian, A.: “Occupational risk of HIV, HBV and HSV-2 infections in health care personnel caring for AIDS patients.” Am J Pub Health 1987; 77:1306–1309.Google Scholar
Fischl, M.A., Richman, D.D., Grieco, M.H. et al: “Azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: A double blind, placebo controlled trial.” Efficacy: NEJM 1987; 317:185–191; Toxicity NEJM 1987;317:192–197; Bolognesi, D.P.: “Prospects for prevention of and early intervention against HIV.” JAMA 1989; 261:3007–3013; Yarchoan, R., Mitsuya, H., Broder, S.: “AIDS therapies.” Scientific American 1988; 259:110–119.Google Scholar
Cowell, M.J., Hoskins, W.H.: “AIDS, HIV mortality and life insurance.” Society of Actuaries (Itasca, Ill), 1987.Google Scholar
Voeller, B., Potts, M.: “Has the condom any proved value in preventing transmission of sexually transmitted viral disease — for example, acquired immunodeficiency syndrome?” Brit Med J 1985: 291:1196; Feldblum, P.J., Fortney, J.A.: “Condoms, spermicides, and the transmission of human immunodeficiency virus.” Am Jour Pub Health 1988; 78:52–549.Google Scholar
Supra note 1.Google Scholar
Recommendations for prevention of HIV transmission in health care settings. MMWR 1987;36:2S–18S.Google Scholar
Hagen, M.D., Meyer, K.B., Pauker, S.G.: “Routine preoperative screening for HIV: Does the risk to the surgeon outweigh the risk to the patient?” JAMA 259:1357–1359, 1988.CrossRefGoogle Scholar
Supra note 7.Google Scholar
Supra note 5.Google Scholar
See supra, notes 5 and 11; Hagen, M.D., Meyer, K.B., Kopelman, R.I., Pauker, S.G.: “Human immunodeficiency virus infection in health care workers: A method for estimating individual occupation risk.” Archives Internal Medicine 149:1541–1544, 1989.Google Scholar
Supra note 3; Hearst, N., Hulley, S.B.: “Preventing the heterosexual spread of AIDS,” JAMA 259:2428–2432, 1988.CrossRefGoogle Scholar
Supra note 10.Google Scholar
McCormick, R.D., Maki, D.G.: “Epidemiology of needle stick injuries in hospital personnel.” Am J Med 1981; 70:928–932.CrossRefGoogle Scholar
Roach, P.J., Fleming, C., Hagen, M.D., Pauker, S.G.: “Prostatic cancer in a patient with asymptomatic HIV infection: Are some lives more equal than others?” Medical Decision Making 1988;8:132–144.Google Scholar
See Hearst, and Hulley, , supra note 15.Google Scholar
Meyer, K.B., Pauker, S.G.: “Screening for HIV: Can we afford the false positive rate?” NEJM 1987; 317:238–241.Google Scholar
Burke, D.S., Brundage, J.F., Redfield, R.R., et al: “Measurement of the false positive rate in a screening program for human immunodeficiency virus infections.” NEJM 1988; 319:961–964.CrossRefGoogle Scholar
Rhame, F.S., Maki, D.G.: “The case for wider use of testing for HIV infection.” NEJM 1989; 320:1248–1253; Weiss, R., Their, S.O.: “HIV testing is the answer — what's the question?” NEJM 1988; 319:1010–1012.Google Scholar
Miike, L.H.: Testimony before Subcommittee on Regulation and Business Opportunities of the House Committee on Small Business. 100th Congress, 1st Session, 1987; Barnes, D.M.: “New questions about AIDS test accuracy.” Science 1987; 238:884–885.Google Scholar
Package Insert: Recombigen HIV-1 LA Test, Cambridge BioScience Corp., Worcester MA.Google Scholar
Cockerill, F.R., Edson, R.S., Chase, R.C., Katzmann, J.A. et al: “False positive” antibodies to human immunodeficiency virus (HIV) detected by an enzyme-linked immunoabsorbent assay (ELISA) in patients at low risk for acquired immunodeficiency syndrome (AIDS).” Proc 3rd Int Conf on AIDS, Washington, DC, June 1–5, 1987, p34. See also supra, note 24.Google Scholar
Meyer, and Pauker, , supra note 20.Google Scholar
Supra note 24.Google Scholar
Supra note 21.Google Scholar
Supra note 24.Google Scholar
Kassirer, J.P., Moskowitz, A.J., Lau, J., Pauker, S.G.: “Decision analysis. A progress report.” Ann Int Med 106:275–291, 1987; Pauker, S.G., Kassirer, J.P.: “Medical Progress: Decision Analysis.” NEJM 316:250–258, 1987; Pauker, S.G., Kassirer, J.P.: “Therapeutic decision making: A cost-benefit analysis.” NEJM 293:229–234, 1975; Pauker, S.G., Kassirer, J.P.: “The threshold approach to clinical decision making.” NEJM 302:1109–1117, 1980.CrossRefGoogle Scholar
Supra note 18.Google Scholar
Supra note 30.Google Scholar
Supra note 7.Google Scholar
Supra note 18.Google Scholar