Gone retroviral: Trauma and HIV

The human immunodeficiency virus (HIV), a retrovirus containing single-stranded ribonucleic acid (RNA), causes HIV infection, and if left untreated, can lead to acquired immunodeficiency syndrome (AIDS). HIV attacks the CD4 cells (T cells) of the immune system, which help the immune system fight off infections. If left untreated, a person is more prone to infections or infection-related cancers. Unlike other viruses, the human body cannot completely eradicate HIV, even with treatment. Once a patient has an HIV infection, he or she has it for life.

So, although there is no cure for HIV, with proper medical treatment, it can be controlled.

HIV transmission and treatment

HIV is transmitted through unprotected sexual intercourse; transfusion of contaminated blood or blood products, contaminated sharp instruments, and from mother to baby during pregnancy, childbirth, and breastfeeding. HIV infection is treated with antiretroviral therapy (ART). With proper compliance and when taken every day, this medicine can significantly prolong the lives of many people infected with HIV, keeping them healthy and reducing the risk of spreading the infection. ART was introduced in the mid-1990s. Until then, HIV infection rapidly progressed to end-stage AIDS within a few years. Today, if diagnosed with HIV before the disease is in an advanced stage, patients on ART can live nearly as long as uninfected individuals.1

More than 1.1 million people living in the U.S. have HIV, and one out of seven are unaware that they have been infected. From 2008 to 2014, the estimated number of annual HIV infections in the U.S. declined 18 percent. The southern states bear the greatest burden, accounting for 50 percent of the new cases reported in 2014. The most at-risk population is young, gay, and bisexual African-American men.2

HIV/AIDS remains a significant global public health challenge, especially in low- and middle-income countries. According to the World Health Organization, at the end of 2015, approximately 36.7 million people were living with HIV, and by mid-2016, 18.2 million people (less than half) were on ART. Nearly 80 percent of pregnant women living with HIV are on ART.3

To examine the occurrence of injured patients with a diagnosis of HIV in the National Trauma Data Bank® (NTDB®) research dataset admission year 2015, medical records were searched using the International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes. Specifically searched were records that contained either diagnosis codes of 042/B20, B21, B22, B23, B24 (HIV disease), or V08/Z21 (asymptomatic HIV/seropositive). A total of 34 records were found, of which 27 contained a discharge status, including 24 patients discharged to home and two to acute care/rehab; one died (see Figure 1). Of these patients, 73 percent were men, on average 47.4 years of age, had an average hospital length of stay of 4.9 days, an intensive care unit length of stay of 4.2 days, an average injury severity score of 9.8, and were on the ventilator for an average of 6.6 days.

Figure 1. Hospital discharge status

Figure 1. Hospital discharge status

Take care

Health care workers, especially those who care for acutely injured patients, often work with limited patient history information and must be prepared to offer intervention of extreme acuity and time sensitivity. Occupational transmission of HIV to health care workers remains extremely rare. As of December 2013, only 58 occupational transmissions of HIV had been confirmed, and 150 possible transmissions had been reported in the U.S. Of these cases, only one has been reported since 1999. Health care workers exposed to a needlestick involving HIV-infected blood at work have a 0.23 percent risk of becoming infected, if treated. Risk of exposure from splashed body fluids, even if bloody, is near zero.4 However, health care professionals who have been exposed to HIV must follow the postexposure plans in place at their institutions. Updated public health service guidelines on postexposure prophylaxis for occupational exposures are available online.

Throughout the year, we will be highlighting these data through brief monthly reports in the Bulletin. The NTDB Annual Report 2016 is available on the American College of Surgeons website as a PDF file. In addition, information is available on the NTDB web page about how to obtain NTDB data for more detailed study. To submit your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org.

Acknowledgment

Statistical support for this column was provided by Ryan Murphy, Data Analyst, NTDB.


References

  1. U.S. Department of Health & Human Services. What are HIV and AIDS? Available at: www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids. Accessed June 29, 2017.
  2. U.S. Department of Health & Human Services. HIV Basics: U.S. Statistics. Available at: www.hiv.gov/hiv-basics/overview/data-and-trends/statistics. Accessed June 29, 2017.
  3. World Health Organization. HIV/AIDS. Available at: www.who.int/hiv/en/. Accessed June 29, 2017.
  4. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention. Occupational HIV transmission and prevention among health care workers. Available at: www.cdc.gov/hiv/pdf/workplace/cdc-hiv-healthcareworkers.pdf. Accessed June 29, 2017.

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