CDC NATIONAL AIDS HOTLINE TRAINING BULLETIN #45 - April 14, 1993
Centers for Disease Control and Prevention

The April 14, 1993, issue of the Journal of the American Medical Association (JAMA) contains three articles describing "lookback" investigations involving the practices of an HIV-infected dentist and two surgeons. Collectively, 2,550 patients, most of whom had undergone invasive procedures, were voluntarily tested for HIV. No instances of HIV transmission from health-care worker to patient were found. These studies support and reinforce CDC's previous statements that the risk of HIV transmission from health-care worker to patient is very small.

CDC provided scientific and technical assistance to health officials who conducted the three investigations; two of the three were supported in part by CDC funds. Patients in these three investigations are among the more than 20,000 patients of HIV-infected health-care workers nationwide who have been tested for HIV as part of lookback investigations. No instance of HIV transmission has been found other than that which occurred in a Florida dental practice. Although seropositive patients were found among those tested in the three investigations published in JAMA, this is not unexpected since an estimated one in 250 persons in the United States is infected with HIV.

CDC has issued guidelines for preventing the transmission of HIV and hepatitis B virus from health-care workers to patients during exposure-prone invasive procedures. CDC has stated that exposure-prone invasive procedures are best determined on a case-by-case basis by local review panels, taking into consideration the specific procedure as well as the skill, technique, and possible impairment of the infected health-care worker. CDC has also stated that mandatory testing of health-care workers is not justified.