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Disclosures: Henderson reports no relevant financial disclosures. Please see the white paper for all other authors’ relevant financial disclosures.
October 16, 2020
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SHEA updates guidance for health care workers with HBV, HCV or HIV

Source/Disclosures
Disclosures: Henderson reports no relevant financial disclosures. Please see the white paper for all other authors’ relevant financial disclosures.
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The Society for Healthcare Epidemiology of America updated its guidance for health care personnel with hepatitis B, hepatitis C or HIV in light of evidence of low transmission and advances in treatments.

“Experience and evidence accumulated over the last decade have made it necessary to revise the guidance. The guidance protects the privacy and health of both health care workers and patients,” SHEA President David K. Henderson, MD, co-chair of the multidisciplinary panel that developed the updated guidance, said in a press release. “Advances in care have reduced the risk for transmission of these bloodborne infections, making it safer for patients and health care personnel. Still, appropriate oversight and training remain foundational.”

According to a white paper published in Infection Control & Hospital Epidemiology, advances in care and 10 years of clinical experience since the last guidance was published necessitated an amendment to the 2010 SHEA guidelines.

The SHEA panel said health care workers (HCWs) must be offered the complete HBV vaccination series. Additionally, congruent with the CDC guidelines, prevaccination testing does not need to be routinely conducted except for HCWs who are at an increased risk for infection, such as those born to mothers from endemic countries and sexually active men who have sex with men. According to the guidelines, the availability of antiviral therapy has “changed the landscape” for HCWs with HBV, with several clinical studies demonstrating that antiviral treatment can lower circulating HBV DNA levels in most patients, often leading to undetectable levels.

SHEA noted that the use of DAAs for HCV has resulted in sustained virologic response rates of nearly 100%, effectively curing HCV in most cases. The new guidance notes the importance of acknowledging substance use disorder among HCWs, which can result in the transmission of HCV to patients. Over the last decade, researchers have learned that more apparent consideration should be given to the possibility of substance use disorder when bloodborne pathogen transmission from HCWs to patients is detected.

Among HCWs with HIV, SHEA noted that ART has changed both the prognosis and risk for transmission to others for people living with HIV. In the past decade alone, new drugs and combination options have made ART less toxic, better tolerated and more effective, while suppressing HIV viral loads to undetectable levels. According to the authors, studies from the last decade have demonstrated that persons living with HIV with undetectable viral loads do not transmit HIV sexually, even during unprotected sex, leading to the conclusion that “undetectable equals untransmittable.”

The authors noted that in the 10 years since the last SHEA guidelines were published, there have been no new reports of HCW-to-patient transmission of HIV.

Henderson and colleagues concluded the guidance by noting that “no guideline, expert guidance, or white paper can anticipate all situations, and this document is not meant to be a substitute for individual judgment of qualified professionals or oversight panels.”

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