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

BACKGROUND: Healthcare workers (HCWs) may be at elevated risk of HIV infection due to the global HIV burden and frequent occupational exposure to blood and body fluids (BBF). This systematic review aimed to estimate the global incidence of occupational HIV seroconversion among HCWs by synthesizing evidence from observational studies. METHODS: This review followed PRISMAguidelines and was registered in PROSPERO. Systematic searches were conductedin six major databases and gray literature to identify observational studies reporting HIV seroconversion following occupational exposure. Studies were included regardless of whether the source patient's HIV serostatus was confirmed, in line with real-world reporting practices. Data were extracted onseroconversion, PEP adherence, exposure type, and follow-up. Meta-analyses of proportions were performed using fixed-effect models with arcsine and Freeman-Tukey double arcsine transformations to account for the rarity of events. Heterogeneity was assessed using I² and tau² statistics. RESULTS: A total of 132 studies were included. The pooled probability of occupational HIV seroconversion across all reported exposures was 0.0125 per 1000 exposure incidents (95% CI:0.0003-0.0425). Among individuals who completed follow-up, the incidence was 0.1215 per 1000 exposure incidents (95% CI: 0.0284-0.2795). For percutaneous exposures, the pooled incidence was 0.5512 per 1000 exposure incidents (95% CI:0.1620-1.1714), and for mucocutaneous exposures, 1.7840 per 1000 exposure incidents (95% CI: 0.7584-3.2409). Among PEP users, the pooled incidence was 0.0098 per 1000 exposure incidents (95% CI: 0.0000-0.3597), compared to 1.7448per 1000 exposure incidents (95% CI: 0.2768-4.4726) among non-adherent individuals. CONCLUSION: Occupational HIV seroconversion among HCWs is rare. Adherence to PEP is associated with reduced transmission risk, reinforcing the importance of timely follow-up and strategies in occupational settings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42023406192.