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Policeman making arrest infected with HIV, HCV
In a bizarre but clearly documented case, epidemiologists report simultaneous transmission of HIV and hepatitis C virus to a policeman who punched a man in the teeth while trying to arrest him.
The case, which occurred in Martinique in the French West Indies, is apparently the first documented report of dual transmission in such a fashion.1
Simultaneous transmission of HIV and HCV has been documented via needlestick.2 In another violent incident, transmission of HIV and hepatitis B virus from a head butt has been previously reported.3
"To our knowledge, this is the first proven case of HIV-HCV co-infection that occurred as the result of a blow with the fist," the investigators report.
The policeman’s sex partner was seronegative for both viruses, and the patient denied having had another sex partner during the previous six months. He had never received blood transfusions and had never been an injection drug user. However, he disclosed that, three weeks before the onset of his illness, he had punched a man in the teeth while making an arrest.
The man who received the punch was known to be infected with HIV, HBV, and HCV, but had declined all treatment. The policeman noticed two wounds on his hand, which was covered with blood.
He did not wash his hand immediately after the incident. Within a few days after the arrest, he developed lymphangitis that required antibiotic treatment. DNA sequencing found the HIV strains in the two men were 98.7% identical and the HCV strains matched 100%.
Although HIV is probably infrequently transmitted via this route, this case raises the question of whether post-exposure prophylaxis should be used after potential exposure to HIV during a bloody fight, especially among individuals with occupational exposures such as police and other public safety officials.
Similarly, the risk of transmission of HCV infection during violent incidents should be taken into account, they recommend.
1. Sylvie A, Cesaire R, Cales-Quist D, et al. Occupational transmission of human immunodeficiency virus and hepatitis C virus after a punch. Clin Infect Dis 2000; 31:1,494-1,495.
2. Ridson R, Gallagher K, Ciesielski C, et al. Simultaneous transmission of human immunodeficiency virus and hepatitis C virus from a needlestick injury. N Engl J Med 1997; 336:919-22.
3. Brambilla A, Pristera R, Salvatori F, Poli G, Vicensi E. Transmission of HIV-1 and HCV by head-butting. Lancet 1997; 350:1,370. n