By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
SYNOPSIS: Evidence indicates that human immunodeficiency virus was transmitted in association with microneedling of facial lesions with platelet-rich plasma.
SOURCE: Stadelman-Behar AM, Gehre MN, Atallah L, et al. Investigation of presumptive HIV transmission associated with receipt of platelet-rich plasma microneedling facials at a spa among former spa clients — New Mexico, 2018-2023. MMWR Morb Mortal Wkly Rep 2024;73:372-376.
A woman in her fifth decade of life was found in the summer of 2018 to have stage 1 human immunodeficiency virus (HIV) infection (positive HIV-1 and HIV-2 antibody together with p24 antigen, negative HIV-1/2 differentiation test, detectable HIV-1 ribonucleic acid [RNA]). The patient had no known HIV risk factors but did indicate that she had undergone a “vampire facial” in the spring of 2018 at a spa (spa A).
Investigations were initiated but were hampered because the facility (and others with the same ownership) was unlicensed and did not have an appointment scheduling system that maintained client contact information. In addition, investigators were unable to collect specimens from the facility because of bureaucratic regulatory reasons. Nonetheless, they were able to identify at-risk clients, including 20 who had received “vampire facials.”
The Centers for Disease Control and Prevention (CDC) identified five individuals first found to be HIV-infected in 2018-2023, which included four former female spa clients as well as a male sexual partner of one of the clients — all of whom denied behavioral risk factors. All four females had received “vampire facials” at spa A. The female–male sexual partners had stage 3 or chronic infection at the time of diagnosis, suggesting that infection antedated the woman’s spa A “vampire facial.” Sequencing studies were performed, and phylogenetic analyses demonstrated that gag, pol, and env constituted, with a high degree of confidence, a monophyletic clade.
Investigation of spa A identified multiple potential hazards, including, e.g., unlabeled tubes of blood, and injectable Botox and lidocaine in a kitchen refrigerator (along with food). No autoclave was on the premises.
COMMENTARY
A “vampire facial” consists of phlebotomy of the client, followed by separation of plasma and cells, and microneedle injection of the platelet-rich plasma (hence the adjective “vampire”) into the face for cosmetic reasons. The CDC states that this outbreak was the first demonstrated association of transmission of HIV with nonsterile cosmetic injection services, in this case, microneedling of platelet-rich plasma. While there was a common type of exposure, the source of contamination remains undetermined, perhaps because of an inability to collect specimens from spa A.
This experience clearly demonstrates the need for effective infection control practices as well as for maintenance of client contact records at sites offering cosmetic injection services.
