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April 14, 1993

Absence of HIV Transmission From an Infected Dentist to His PatientsAn Epidemiologic and DNA Sequence Analysis

Author Affiliations

From the Medical (Drs Dickinson, Klimas, and Bisno) and Dental (Drs Morhart and Laracuente) Services of the Miami (Fla) Veterans Affairs Medical Center; Department of Medicine, the University of Miami (Fla) School of Medicine (Drs Dickinson, Bisno, and Klimas); and Division of HIV/AIDS, Centers for Disease Control and Prevention (Dr Bandea), Atlanta, Ga.

JAMA. 1993;269(14):1802-1806. doi:10.1001/jama.1993.03500140054035

Objective.  —To determine if a general dentist with human immunodeficiency virus (HIV) infection transmitted HIV to any of his patients.

Design.  —A cohort study in which all patients treated by a dentist who developed the acquired immunodeficiency syndrome (AIDS) were identified and attempts were made to contact all patients for HIV antibody testing.

Setting.  —A general dentistry clinic operated by the Department of Veterans Affairs in southeastern Florida.

Participants.  —All patients treated by a dentist during the 5¾ years before he developed AIDS were identified in a computerized registry of dental care.

Main Outcome Measures.  —Attempts were made to contact all living patients for counseling and HIV antibody testing. Living patients with newly identified HIV infection were interviewed, and DNA sequence analysis was performed to compare genetic relatedness of their HIV to that of the dentist. Death certificates were obtained for deceased patients, and the medical records of those with diagnoses suggestive of HIV disease or drug abuse and those dying under the age of 50 years were reviewed in detail.

Results.  —There were 1192 patients who had undergone 9267 procedures, of whom 124 were deceased. A review of the death certificates of the deceased patients identified five who had died with HIV infection, all of whom were either homosexuals or users of illicit intravenous drugs. We were able to locate 962 (92%) of the remaining 1048 patients, and 900 agreed to be tested. Infection with HIV was documented in five of the 900 patients, including four who had clear evidence of risk factors for acquiring HIV infection. One patient who had only a single evaluation by the dentist denied high-risk behavior. Comparative DNA sequence analysis demonstrated that the viruses from the dentist and these five patients were not closely related.

Conclusion.  —This study indicates that the risk for transmission of HIV from a general dentist to his patients is minimal in a setting in which universal precautions are strictly observed. Programs to ensure compliance with universal precautions would appear preferable to programs for widespread testing of dentists.(JAMA. 1993;269:1802-1806)