Non-Cochrane · prognostic · PM42310740

Incidence of occupational HIV seroconversion among healthcare workers: a systematic review and meta-analysis.

Marques-Medeiros Ana Carolina, Zina Livia Guimarães, Abreu Lucas Guimarães, et al. · BMC health services research · 2026 · PubMed · doi:10.1186/s12913-026-14515-0

Findings

30 findings

Population
Healthcare workers with occupational exposure to blood and body fluidsTotal reported occupational exposuresNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%) reporting seroconversion
Pooled incidence (cumulative proportion) 1.13561 [0.60162, 1.83756]
GRADE not reported
9 studies · 11409 participants
Healthcare workers with occupational exposure to blood and body fluidsTotal reported occupational exposuresNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols
Pooled incidence (cumulative proportion) 0.01248 [0.00030, 0.04248]
Very low
Downgraded: risk of bias
132 studies · 107819 participants
Healthcare workers with occupational exposure to blood and body fluidsTotal reported occupational exposuresNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Sensitivity analysis excluding high risk of bias studies
Pooled incidence (cumulative proportion) 0.01279 [0.00033, 0.04329]
GRADE not reported
124 studies · 106496 participants
Healthcare workers with occupational exposure to blood and body fluidsTotal reported occupational exposuresNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with high HIV prevalence (>1%)
Pooled incidence (cumulative proportion) 0.00000 [0.00000, 0.23056]
GRADE not reported
10 studies · 4165 participants
Healthcare workers with occupational exposure to blood or body fluidsOccupational exposure to blood or body fluids (incidence, no intervention)None (single-group incidence)HIV seroconversion, exposed individuals who completed serological follow-up
Serological follow-up per institutional or national protocol · Healthcare settings worldwide · Studies conducted in low-prevalence countries (<1%) that reported seroconversion
Pooled incidence (per 1000 exposure incidents) 1.39150 [0.73202, 2.26059]
GRADE not reported
Studies not reported
Healthcare workers with occupational exposure to blood and body fluidsTotal reported occupational exposuresNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%)
Pooled incidence (cumulative proportion) 0.01378 [0.00044, 0.04565]
GRADE not reported
122 studies · 103604 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposures with completed serological follow-upNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Sensitivity analysis excluding high risk of bias studies
Pooled incidence (cumulative proportion) 0.12241 [0.02871, 0.28119]
GRADE not reported
106 studies · 29501 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposures with completed serological follow-upNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with high HIV prevalence (>1%)
Pooled incidence (cumulative proportion) 0.00000 [0.00000, 0.86650]
GRADE not reported
10 studies · 1108 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposures with completed serological follow-upNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols
Pooled incidence (cumulative proportion) 0.12153 [0.02840, 0.27952]
Low
Downgraded: risk of bias
110 studies · 29607 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposures with completed serological follow-upNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%)
Pooled incidence (cumulative proportion) 0.11209 [0.02628, 0.25754]
GRADE not reported
102 studies · 32200 participants
Healthcare workers with occupational exposure to blood and body fluidsPercutaneous occupational exposureNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols
Pooled incidence (cumulative proportion) 0.55123 [0.16200, 1.17141]
Low
Downgraded: risk of bias
35 studies · 8307 participants
Healthcare workers with occupational exposure to blood and body fluidsPercutaneous occupational exposureNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with high HIV prevalence (>1%)
Pooled incidence (cumulative proportion) 0.00000 [0.00000, 9.38583]
GRADE not reported
2 studies · 102 participants
Healthcare workers with occupational exposure to blood and body fluidsPercutaneous occupational exposureNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%) reporting seroconversion
Pooled incidence (cumulative proportion) 2.92221 [1.52116, 4.77669]
GRADE not reported
7 studies · 4224 participants
Healthcare workers with occupational exposure to blood and body fluidsPercutaneous occupational exposureNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%)
Pooled incidence (cumulative proportion) 0.30725 [0.08002, 0.68174]
GRADE not reported
42 studies · 13034 participants
Healthcare workers with occupational exposure to blood and body fluidsPercutaneous occupational exposureNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Sensitivity analysis excluding high risk of bias studies
Pooled incidence (cumulative proportion) 0.56654 [0.16842, 1.19878]
GRADE not reported
34 studies · 8194 participants
Healthcare workers with occupational exposure to blood and body fluidsMucocutaneous occupational exposureNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%) reporting seroconversion
Pooled incidence (cumulative proportion) 0.01128 [0.00000, 0.35718]
GRADE not reported
7 studies · 3976 participants
Healthcare workers with occupational exposure to blood and body fluidsMucocutaneous occupational exposureNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%)
Pooled incidence (cumulative proportion) 0.00111 [0.00000, 0.09534]
GRADE not reported
24 studies · 12660 participants
Healthcare workers with occupational exposure to blood and body fluidsMucocutaneous occupational exposureNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with high HIV prevalence (>1%)
Pooled incidence (cumulative proportion) 1.80000 [0.00000, 36.48455]
GRADE not reported
1 study · 26 participants
Healthcare workers with occupational exposure to blood and body fluidsMucocutaneous occupational exposureNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols
Pooled incidence (cumulative proportion) 1.78404 [0.75836, 3.24085]
Very low
Downgraded: risk of bias, publication bias
19 studies · 4439 participants
Healthcare workers with occupational exposure to blood and body fluidsMucocutaneous occupational exposureNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Sensitivity analysis excluding high risk of bias studies
Pooled incidence (cumulative proportion) 1.79858 [0.76620, 3.26384]
GRADE not reported
18 studies · 4421 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposure with PEP useNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Sensitivity analysis excluding high risk of bias studies
Pooled incidence (cumulative proportion) 0.00984 [0.00000, 0.36101]
GRADE not reported
45 studies · 3816 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposure with PEP useNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols
Pooled incidence (cumulative proportion) 0.00978 [0.00000, 0.35969]
Low
Downgraded: risk of bias
47 studies · 3828 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposure with PEP useNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%) reporting seroconversion
Pooled incidence (cumulative proportion) 4.83718 [0.00000, 20.68662]
GRADE not reported
3 studies · 172 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposure with PEP useNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with high HIV prevalence (>1%)
Pooled incidence (cumulative proportion) 0.00000 [0.00000, 1.39119]
GRADE not reported
8 studies · 690 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposure with PEP useNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%)
Pooled incidence (cumulative proportion) 0.01125 [0.00000, 0.39021]
GRADE not reported
43 studies · 3570 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposure with PEP indication and no PEP useNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%)
Pooled incidence (cumulative proportion) 0.00000 [0.00000, 0.00000]
GRADE not reported
25 studies · 1746 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposure with PEP indication and no PEP useNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols
Pooled incidence (cumulative proportion) 1.74481 [0.27683, 4.47259]
Very low
Downgraded: risk of bias, publication bias
21 studies · 1519 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposure with PEP indication and no PEP useNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with high HIV prevalence (>1%)
Pooled incidence (cumulative proportion) 0.00000 [0.00000, 0.20000]
GRADE not reported
4 studies · 238 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposure with PEP indication and no PEP useNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Sensitivity analysis excluding high risk of bias studies
Pooled incidence (cumulative proportion) 0.00000 [0.00000, 0.00000]
GRADE not reported
21 studies · 1519 participants
Healthcare workers with occupational exposure to blood and body fluidsOccupational exposure with PEP indication and no PEP useNone (single-group pooled incidence)HIV seroconversion (cumulative incidence)
Follow-up per study protocols · Studies from countries with low HIV prevalence (<1%) reporting seroconversion
Pooled incidence (cumulative proportion) 0.00000 [0.00000, 0.20000]
GRADE not reported
4 studies · 1127 participants

Included primary studies 124

Open in Studies
StudyYearAlso included byOutcomes it informs hereTrial data
Ramos-Gomez et al., 1995
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Abubakar et al., 2018
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Al Ghamdi S et al., 2003
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Alavi and Sharifi, 2013
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Almeida and Benatti, 2007
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Andrade et al., 2014
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Argentero et al., 2007
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Arva et al., 1990
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Aydın, Ergen and Çaşkurlu, 2020
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Baldo et al., 2014
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Barriga Angulo et al., 1989
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Beghdadli et al., 2009
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Bowden et al., 1993
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Bozkurt et al., 2013
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Çağlar-Özer, Altunal and Kadanalı, 2020
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Çelik, 2017
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Chaiwarith et al., 2013
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Changraksa et al., 2022
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Cleveland et al., 2002
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Daglio et al., 2006
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Dizili-Yelgin C et al., 2018
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Ehui et al., 2007
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El-Hazmi and Al-Majid, 2008
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Elmsli, 1989
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Elmslie and O’Shaughnessy, 1988
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Erhabor and Nwauche, 2007
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Escudero, Furtado and Medeiros, 2015
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Fadil et al., 2021
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Fahey et al., 1991
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Fillaux et al., 2004
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Forseter, Joline and Wormser, 1994
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Frijstein, Hortensius and Zaaijer, 2011
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Gerberding et al., 1987
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Gerberding, 1994
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Goel et al., 2017
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Gupta et al., 2008
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Gutierrez, Lopes e Yasuda, 2005
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Haytoglu and Gundeslioglu, 2018
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Henderson et al., 1986
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Hiransuthikul, Hiransuthikul and Kanasuk, 2007
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Ippolito, Puro and De Carli, 1993
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Jaggi, Nirwan and Chakrabort, 2020
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Jayanth et al., 2009
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Jeong, 2014
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Juanes et al., 2007
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Kaya et al., 2012
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Kepenek and Şahin-Eker, 2017
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Krishnan et al., 2016
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Lee and Choi, 2023
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Loureiro et al., 2009
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Lymer, Schiitz and Isaksson, 1996
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MacDonald,1996
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Miceli, 2005
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Miller and Farr, 1989
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Murray et al., 2009
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Nwaiwu et al., 2017
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O’Connell and Hayes, 2003
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Oakley, Gooch and Cockcroft, 1992
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Oh, Yi and Choe, 2005
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Pedersen, 1996
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Pérez-Diaz et al., 2015
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Placidi et al., 2002
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Porter et al., 1990
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Puro et al., 1992
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Puro, Ranchino and Profili, 1990
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Rajkumari et al., 2014
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Razzakh and Qureshi, 2021
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Rele,Mathur and Turbadkar, 2002
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Rice, Tomkins and Ncube, 2015
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Ricketts et al., 1992
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Rishi et al., 2017
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Roberts, Lincoff and Frankel, 1991
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Rogowska-Szadkowska et al., 1997
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Sarkar and Lahiri, 2021
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Schmid, Schwager and Drexler, 2007
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Shanks and Al-Kalai, 1995
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Sheth, Leuva and Mannari, 2016
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Shriyan et al., 2012
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Strickler, 1988
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Tokars et al., 1993
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Wnuk, 2003
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Overlap with other reviews

Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.

Review question

ElementPlanned (methods)Found (results)
PopulationHealthcare workers exposed to blood or body fluids (CoCoPop: Condition = HIV seroconversion; Context = occupational exposure to blood or body fluids; Population = healthcare professionals)Healthcare workers with occupational exposure (n=107819 exposures in 132 studies)
InterventionNot applicable (incidence review; occupational exposure to blood or body fluids)Not applicable
ComparisonNot applicableNot applicable
OutcomesHIV seroconversion (pooled cumulative incidence) overall, among those completing follow-up, by exposure type (percutaneous, mucocutaneous), with PEP use, and with PEP indication but no PEP usePooled seroconversion incidence per 1000 exposure incidents: all exposures 0.01248 (n=132 studies); completed follow-up 0.12153 (n=110); percutaneous 0.55123 (n=35); mucocutaneous 1.78404 (n=19); PEP users 0.00978 (n=47); PEP indicated without PEP 1.74481 (n=21)
Study designsObservational studies (prospective and retrospective cohorts; cross-sectional studies reporting exposures and follow-up); no language or date restrictions132 observational studies (49 prospective, 82 retrospective, 1 both)
TimingSerological follow-up per institutional or national post-exposure protocolsNot specified