WEST PALM BEACH, Fla. -- Infection-control techniques used by a Florida dentist did not measure up to national Centers for Disease Control standards and may have led to AIDS infections in three of his patients, according to the final draft of a CDC report to be published tomorrow.
Genetic tests "strongly suggest" that Dr. David Acer somehow infected three of his patients, including Kimberly Bergalis, 22, who is suing her insurance provider for sending her to Dr. Acer, Ms. Bergalis' lawyers said.
"This is absolute confirmation that Kimberly and the other two patients were infected by Dr. Acer," said attorney David Eaton.
The CDC announced in August that Ms. Bergalis was believed to be the first person in the United States to contract acquired immune deficiency syndrome from an infected health care worker. She read a final draft of the report this week with her lawyers.
In an earlier report, the CDC linked Dr. Acer's virus to Ms. Bergalis' virus but questioned how the dentist could have transmitted the disease. The new report says poor hygiene may have been the culprit.
CDC and state health officials interviewed 12 of Dr. Acer's employees, Mr. Eaton said.
"His staff told the CDC that they only disinfected when time permitted," Mr. Eaton said. "That's terrible. They said he didn't change his gloves after patients. He just washed them."
Using soap on gloves destroys their integrity and makes it easier for blood to pass through the latex, Mr. Eaton said.
The two other patients included in the report show no other risk factors for AIDS, Mr. Eaton said. Their viruses are similar in genetic structure to Ms. Bergalis' and Dr. Acer's viruses, he said.
One, a married, middle-aged woman, shows no symptoms of the disease, Mr. Eaton said. The other, a young married man who had several sexual partners, has one symptom: a low T-cell count. T-cells contribute to the body's disease-fighting mechanism. Both patients are receiving AIDS counseling.
Genetic tests on the AIDS virus of another former patient have not been completed, Mr. Eaton said.
Dr. Acer, a bisexual who came down with full-blown AIDS three months before treating Ms. Bergalis in 1987, never told his patients he had the disease but claimed before he died in September that he followed standard precautions against infection.
The human immunodeficiency virus, which causes AIDS, is transmitted by blood-to-blood contact, intravenous drug use, sexual intercourse and birth.
The report also includes the results of a random blood sampling of people with the AIDS virus in the area where Dr. Acer practiced. Late last year, state health officials submitted 100 blood samples to CDC for random genetic testing. Of the 100, scientists did genetic sequencing on eight samples. None matched Dr. Acer's virus, Mr. Eaton said.
"The medical profession is going to change their tune," Mr. Eaton said. "They were very brutal to Kimberly. They didn't believe her. Today they told Kimberly they were sorry.
"But one of Kimberly's missions was to see the CDC guidelines changed in her lifetime, and that's going to happen."
Since the first report linking the dentist to Ms. Bergalis was published in July, the CDC has been discussing revising the guidelines for health care workers. In August, the CDC convened a meeting of the nation's top health professionals to propose new guidelines. The results are expected next month, said CDC spokesman Kent Taylor.
The guidelines now in place assume that the risk of a health care worker's passing a virus to a patient is negligible.
The CDC advised that an AIDS-infected doctor using proper precautions could continue practicing medicine.
A change in the guidelines could impose tougher restrictions on health care workers with AIDS.