The Associated Press, Thurs, 15 Dec 1994.

But federal researchers found one crucial difference between Dr. David Acer and a second, unidentified Miami dentist: The latter, they say, didn't give his patients AIDS.

Two years after a federal study concluded that six of Acer's patients contracted HIV from him, a second study of another dentist has found exactly the opposite. Leaders of the dental profession were ecstatic.

"It tells a very stable, comforting story to the American public," said Dr. John S. Zapp, executive director of the Chicago-based American Dental Association.

The new study by the federal Centers for Disease Control and Prevention and the Florida Health Department used DNA sequencing to isolate the strain of HIV carried by the unidentified dentist from Miami.

Despite finding that the dentist used imperfect infection control procedures, the research uncovered no evidence that his HIV-positive patients contracted their infections from him. The DNA of their virus did not match his, researchers said.

The study, published in the Dec. 1 issue of the Philadelphia-based Annals of Internal Medicine, also concluded that the dentist's patients did not contract the virus from one another -- in effect, that unclean dental implements did not act as conduits.

"This follow-up helps put the Acer investigation in better perspective," said Dr. Harold W. Jaffe, the study's leader and director of the CDC's Division of HIV-AIDS.

"It tells us that the risk from dentist to patient is very low, and based on that low risk we don't favor mandatory screening of health care providers," Jaffe said.

Acer, of Jensen Beach, Fla., died in 1990 after infecting six patients, the CDC said -- including Kimberly Bergalis, who waged a crusade for mandatory testing of health care workers before she died in December 1991.

Acer is the only health professional ever known to have transmitted HIV to his patients.

The second dentist practiced in the Liberty City area of Miami for nearly 30 years and served a primarily indigent population with a high rate of reported AIDS cases.

He tested HIV-positive himself in June 1988 and died in a hospice in August 1991.

Of 6,474 patients who had records of receiving care from the dentist during his final five years of practice, 1,279 underwent HIV tests and 24 tested positive. Four others were identified through other means.

According to the study, all but four of the 28 HIV-positive patients had potential behavioral risks. DNA sequencing of the viruses did not indicate the dentist's HIV and the patients' were linked.

"If the dentist had been the source of infection to some of his patients, we would expect their viruses to look very similar," Jaffe said. "But instead, we found that each of the infected patients and the dentist had distinct strains, suggesting that each was infected independently."

Researchers, though, acknowledged that dental instruments contaminated with blood or tissue could conceiveably transmit HIV between patients. They also said their study was limited by the sample -- about 20 percent of all the dentist's patients.

Some AIDS experts said the new study could help quell the fear that caused some people to question the entire dental profession after Bergalis' death.

"There might be a sort of momentary message that reinforces the good news that's been coming out of CDC," said Gerald Myers, director of the HIV Sequence Database and Analysis Project at Los Alamos National Laboratory. His quasi-governmental organization tracks different strains of HIV.

"On the other hand," he cautioned, "it doesn't mean that by the turn of the century, when the number of cases has doubled, that we won't see another case like the Acer case."

For the American dental profession, which handles more than 400 million patient-visits each year and has recently conducted a safe-practices campaign, the study comes as good news.

"The Acer case has been pretty much put to rest," Zapp said. "People see increasingly visible infection control procedures in place -- things they didn't see in previous years."

Robert Montgomery, who represented Bergalis and three other Acer patients, warned against false security. He said the study should not be used to oppose mandatory testing of health professionals.

"The patient has a right to know. That's how simple it is," said Montgomery, who keeps a picture of Bergalis on his office desk.

"We know that Acer infected these patients," he said. "Whether it was done negligently or deliberately, the public health services allowed Acer to be in a position to hurt somebody."

Copyright (c) 1994 - The Associated Press. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Permissions Desk, The Associated Press, 50 Rockefeller Plaza, New York, NY 10020. Copyright (c) 1994 - The Associated Press. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Permissions Desk, The Associated Press, 50 Rockefeller Plaza, New York, NY 10020.
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Copyright © 1994 - Associated Press. Reproduction of this article (other than one copy for personal reference) must be cleared through the AP Permissions Desk.

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