When Does Autopsy Become a Real Infection Risk? A Systematic Review Integrating Percutaneous Injury Incidence with Postmortem Viral Viability of Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus

Abstract Autopsy practice carries an inherent risk of occupational exposure to blood–borne pathogens, particularly through percutaneous injury. While postmortem persistence of viral markers is well documented, true infection risk depends on the coexistence of procedural exposure and biologically viable virus rather than molecular detectability alone. This systematic review aimed to determine when autopsy practice constitutes a real biological infection risk by integrating evidence on autopsy-related percutaneous injury with postmortem viral viability of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted across major biomedical databases. Studies reporting autopsy-related percutaneous injury or glove perforation, as well as experimental or clinical investigations of postmortem viral persistence or infectivity, were included. Viral outcomes were classified using a predefined tiered hierarchy distinguishing confirmed infectivity from molecular detection. Evidence was synthesized into a postmortem interval (PMI)-based viral risk matrix and a procedure–personal protective equipment intersection map. Ten primary studies met the inclusion criteria. Autopsy-related percutaneous breaches were frequent and often unrecognized, particularly during evisceration, organ handling, suturing, and blade changes. Replication-competent HIV was consistently demonstrated in postmortem specimens during early PMI and under refrigerated conditions, whereas HBV infectivity evidence was limited, and HCV infectivity was not demonstrated despite persistent molecular detectability. Real infection risk was identified only where high-risk procedures coincided with PMIs supported by Tier 1 infectivity evidence. Autopsy-related infection risk is condition-dependent and virus-specific. Integrating exposure mechanics with biological viability provides a more accurate framework for occupational risk assessment than molecular detection alone.