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DENVER -- Five cases of HIV infection associated with cosmetic platelet-rich plasma (PRP) microneedling, known as a "vampire facial," were linked to one spa in New Mexico, according to a report from CDC investigators.

From 2018 to 2023, four former clients of the spa and one sexual partner of a client were diagnosed with HIV, reported Anna Behar, PhD, MPH, of the CDC, at the Conference on Retroviruses and Opportunistic Infections.

Although few in number, the cases are important because HIV transmission through cosmetic injection services, such as PRP microneedling, has not been previously documented in the U.S., Behar told attendees. "This investigation is the first to demonstrate HIV transmission through unsterile cosmetic injection services in a spa setting," she said.

The term "vampire facial" comes from blood droplets left on the skin after injection of PRP. The procedure has been popularized by celebrities such as Kim Kardashian.

The New Mexico Department of Health (NMDOH) was alerted to the first case in the summer of 2018 when a female client of the Albuquerque spa received an HIV diagnosis after taking a rapid antigen test while she was traveling abroad. The client had no known HIV risks, except that she had received cosmetic PRP microneedling at the spa that spring. This led the NMDOH and the CDC to rapidly launch an investigation into the possible transmission of HIV at the spa, which has now spanned over 5 years and is still ongoing, Behar said.

Aside from the attention-grabbing aspect of the study, "it's a critical regulatory issue that these clinics seem to be under-regulated and [the procedure] has not been sufficiently understood as having a risk of transmission," session moderator Aaron Siegler, PhD, MHS, of the Rollins School of Public Health at Emory University in Atlanta, told 乌鸦传媒. "It's important for clinicians to be aware that potentially blood-based [HIV] transmission may occur in novel non-hospital settings. Clinicians may encounter patients with unexpected sources of transmission and they should be followed up carefully."

Investigators Find Unsanitary Conditions at Spa

In the 2018 inspection, NMDOH and CDC investigators found "dozens" of used needles throughout the spa, improperly disposed of in multiple trash cans and stuffed into drawers in the client treatment rooms. Unlabeled syringes "loaded with unknown biologics" were stored next to coffee creamer and cheese slices in a snack refrigerator, and investigators also found unlabeled tubes and vials of human blood in the refrigerator, Behar told attendees. "Many of the vials appear to have been used several times," she noted, as she shared photographs from inside the spa.

"Clearly, there was a wide scope of contamination and infection control violations at the spa that indicated the potential for transmission of multiple blood-borne pathogens from multiple sources," Behar said.

To top things off, the spa owner had failed to keep a full list of clients, their contact details, or scheduling information.

Phylogenetic Analysis Linked HIV Cases

The investigators managed to piece together a list of potentially infected clients by cross-referencing spa records and through community outreach. They were able to identify 20 clients who received vampire facials and 59 clients who received other injection services, such as Botox, at the spa during the spring and fall of 2018. In total, Behar and colleagues tested 198 former spa clients and their sexual partners from 2018 to 2023, but identified no new HIV, hepatitis B, or hepatitis C infections.

However, healthcare providers in New Mexico alerted investigators to four new patients with HIV who had links to the spa. Of the total five cases, Cases 1, 2, 3, and 5 had received at least one vampire facial at the spa during the period of interest. Case 3 had been screened for HIV in the summer of 2016 when applying for life insurance, but was only diagnosed in the fall of 2021 with stage 3 HIV. Case 4 was the sexual partner of Case 3.

Phylogenetic analysis revealed that the HIV genetic sequences from all patients clustered together strongly. This evidence indicated that Cases 3 and 4 could be attributed to exposures prior to receiving vampire facials, Behar said. The other three patients in this cluster had no known social contact with each other, suggesting that poor infection control processes and contamination at the spa resulted in HIV infection for Cases 1, 2, and 5.

Conference attendee Renslow Sherer, MD, of the University of Chicago, pointed out during a Q&A session that the implication of Behar's study was that HIV-contaminated products at the spa originated with Case 3 who had been infected with HIV since at least 2016. Behar replied that she could not comment on the directionality, since it was out of the scope of the analysis, but added that "the contamination that happened at the spa and the lack of infection control practices allowed for the transmission of HIV."

Those who want to get a vampire facial need to protect themselves by making sure the facility has a clinical license to perform cosmetic injections, uses sterile supplies, and appropriately labels specimen containers, Behar advised.

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