The Mechanism of HIV Infection in Patients of the Florida Dentist-Reply

Carol A. Ciesielski, MD; Ruth L. Berkelman, MD; Harold W. Jaffe, MD
JAMA. 1991;266(18):2559. doi:10.1001/jama.1991.03470180059023.
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In Reply.  —We do not believe that five patients of a Florida dentist became infected with HIV as a consequence of exposure to the sweat of a dentist with AIDS.1-3 None of the five infected patients reported any contact with perspiration from the dentist. Furthermore, HIV has not been demonstrated in "natural" eccrine sweat from HIV-infected patients,4 nor is there evidence to indicate that hepatitis B virus, another bloodborne pathogen with epidemiologic transmission patterns similar to HIV, can be transmitted through this route.Although the precise mode of HIV transmission to these patients remains uncertain, all of the patients had dental care from the dentist after he was diagnosed with AIDS, and multiple opportunities existed for the dentist to sustain needlestick injuries (eg, during administration of local anesthetics, two-handed needle recapping procedures, and suturing) or cuts with a sharp instrument, particularly in poorly visualized operative sites. Alternatively, transmission


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