The continuing AIDS (Acquired Immunodeficiency Syndrome) pandemic recently completed its 25th year. The beginning of AIDS was inauspicious. The first recorded cases were included in a brief public health report. The article, published in the June 5, 1981, issue of the CDC’s Morbidity and Mortality Weekly Report, described the detection of an unusual form of immune deficiency in five previously healthy, young, homosexual men. In each instance, the men developed infections and neoplasia consistent with the suppression of normal T-lymphocyte cellular immune defenses. A second CDC report then described a larger number of cases of Pneumocystis carinii pneumonia and Kaposi’s sarcoma in 26 homosexual men in New York City and California. Later, detailed descriptions of the first cases of Pneumocystis carinii pneumonia, extensive mucocutaneous candidiasis, Kaposi’s sarcoma, and multiple viral infections were punctuated with statements reinforcing the premise that Pneumocystis infection was a rare disease. In virtually every occurrence, diagnosed patients were severely immunosuppressed individuals. In addition, Kaposi’s sarcoma was previously considered a rare form of cancer, diagnosed only among certain groups of persons, including elderly Mediterranean men and organ transplant patients. While this unusual form of cancer was only briefly mentioned in most medical and dental school pathology courses before 1981, it would become a common, extensively studied manifestation of progressive HIV infection and AIDS. This proved to be the dawning of the AIDS pandemic.
The statistics and toll in human suffering and death of HIV are staggering. Epidemiological information suggests that approximately 50 million people have HIV infection and AIDS. One million of these people live in the United States. With 6,000 new infections a day, an estimated 40,000 people could be added to the HIV-infected total in 2006. More than 22 million people have died from AIDS complications since the first five AIDS deaths were reported, including more than 500,000 deaths in the U.S. Once considered a disease found only in one or two “high-risk groups” of people, it is now detected in all segments of the population.
Despite the absence of an effective vaccine and curative anti-HIV medications, newer prevention strategies have led to a series of invaluable diagnostic and screening tests. The application of these assays effectively have changed some of the early pandemic epidemiological trends by providing valuable tools to minimize the potential for viral transmission in certain circumstances. This is evidenced by the routine screening of donated blood and tissues, using highly sensitive assays to ascertain donor HIV serostatus. Since the first screening of anti-HIV blood tests was instituted in the mid-1980s, improved technology has continued to allow detection of low concentrations of anti-HIV antibodies and viable virions in blood and other body fluids such as saliva. As a result, the current risk for HIV transmission from blood transfusion in the U.S. is estimated to be as low as one case per two million blood donations. The use of HIV serology is also a major factor responsible for the noted decrease in perinatal HIV transmission in the U.S.
The second purpose for reviewing the above disease statistics is to point out how far the dental profession has come in caring for people with HIV infection. Dentistry has moved toward acceptance and use of universal (now standard) precautions as the basis for routine infection control. The misguided perception that care for HIV-infected patients required double gloving, separate cleaning and sterilization of instruments, overspraying contaminated surfaces with liquid disinfectants, or other special precautions, has long since been proven inappropriate. Even though HIV is far more difficult to transmit than hepatitis B virus and hepatitis C virus in health-care settings, it was the spark that moved many health professionals to utilize routinely effective, prescribed precautions. As more clinicians realized they were treating previously undisclosed HIV-infected patients, they became more comfortable with a variety of precautions we now take for granted. Continued surveillance of occupational HIV infections in health-care workers also has been instrumental in reinforcing the effectiveness of infection prevention practices. Since the first HIV surveillance efforts were instituted in 1984, we have not seen the first case of occupational HIV infection in a dental professional. It is already evident, however, that with the long-term acceptance and use of infection control procedures, dentistry has become a much safer health profession by protecting the major targets of occupational bloodborne infection - the dentists, dental hygienists, dental assistants, and lab technicians.
Dr. John A. Molinari is professor and chairman of the Department of Biomedical Sciences at the University of Detroit Mercy School of Dentistry. Contact him at (313) 494-6632, or [email protected].
