Management of healthcare personnel living with hepatitis B, hepatitis C, or human immunodeficiency virus in US healthcare institutions

• Published in: Infection control and hospital epidemiology 2022-02, Vol.43 (2), p.147-155
• Main Authors: Henderson, David K, Dembry, Louise-Marie, Sifri, Costi D, Palmore, Tara N, Dellinger, E Patchen, Yokoe, Deborah S, Grady, Christine, Heller, Theo, Weber, David, Del Rio, Carlos, Fishman, Neil O, Deloney, Valerie M, Lundstrom, Tammy, Babcock, Hilary M
• Format: Article
• Language: English
• Subjects: Antigens; Antiretroviral drugs; Antiviral drugs; Delivery of Health Care; Disease control; Drug therapy; Drug use; Epidemics; FDA approval; Health care; Health Personnel; Hepacivirus; Hepatitis; Hepatitis B; Hepatitis B - epidemiology; Hepatitis B - prevention & control; Hepatitis B virus; Hepatitis C; Hepatitis C - epidemiology; HIV; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Immune system; Immunization; Infections; Interferon; Medical personnel; Pathogens; Patients; Postpartum period; Prevention; Public health; Substance abuse treatment; Substance use disorder; Vaccines; Viruses
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2020.458

In 1991, the Centers for Disease Control and Prevention (CDC) published guidelines designed to prevent HCP-to-patient transmission of hepatitis B virus (HBV) and human immunodeficiency virus (HIV).2 This set of guidelines stated that HCP, “… who are infected with HIV or HBV (and are HBeAg positive) should not perform exposure-prone procedures unless they have sought counsel from an expert review panel and been advised under what circumstances, if any, they may continue to perform these procedures. 2,5 In 2013, the CDC Advisory Committee on Immunization Practices (ACIP) issued updated guidance about the assessment of immunity to HBV in HCP, including postexposure management strategies.6 More recently, the Communicable Disease Network of Australia (CDNA) published updated guidelines for managing HCP living with bloodborne pathogens,7 the Public Health Agency of Canada (PHAC) published an exhaustive guideline for the prevention of transmission of bloodborne viruses from HCP to their patients.8 The United Kingdom published guidance in July 2019 on the health clearance and management of HCP living with a bloodborne pathogen,9 and CDC issued testing and follow-up information for HCP potentially exposed to HCV.10 The following section summarizes the changes involved in the management and treatment of these pathogens since 2010. A recent report has documented 4 instances of chronic HBV infection in HCP who failed to respond to 2 courses of vaccination.13 The availability of antiviral therapy has changed the landscape for HCP living with hepatitis B. A substantial pharmacologic armamentarium has been developed to suppress hepatitis B viral load substantially, including 7 US Food and Drug Administration (FDA)–approved agents: tenofovir, entecavir, lamivudine, telbivudine, adefovir, interferon α, and pegylated interferon. Since the publication of the previous guidance, only 2 instances of HCP-to-patient transmission of HBV have been reported in the literature.14,15 In both instances, neither HCP (an orthopedist and a gynecologic surgeon) was aware of the hepatitis B infection, and, thus, neither was on treatment. Hepatitis C virus (HCV) The less effective and poorly tolerated interferon-plus-ribavirin therapies used since the 1980s for treatment of HCV infection have been replaced in the past decade by the development and FDA approval of >10 drugs or drug combinations that act directly on the hepatitis C virus (direct-acting antivirals, or DAA).