The Unsolved Mystery Of The AIDS Dentist

By Alan Boyle on Friday, October 25, 2013
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“My curse upon thy venom’d stang, / That shoots my tortured gums alang.” —Robert Burns, Address to the Toothache

In A Nutshell

In the late 1980s, Dr. David Acer, a dentist working in Florida, passed an HIV infection to six of his patients. There have only been three other instances worldwide since, making Dr. Acer responsible for two-thirds of people ever infected by a healthcare worker. No one has any idea how it happened. Some suggest he did it deliberately, but there is neither evidence nor a plausible method that anyone can think of. It is a medical mystery that will probably remain unsolved.

The Whole Bushel

In 1991, a young Floridian woman named Kimberly Bergalis died as a result of AIDS. She is recorded as the first person in history to have been infected by a healthcare worker, her dentist Dr. David Acer. He had pulled two teeth from Kimberly and in the process passed on his infection. Hundreds of Dr. Acer’s other patients were tested and ultimately five more were found with the infection. Emily’s family sought to put things right by fighting for a ban on healthcare workers with the virus performing invasive procedures. Her father said, “someone who has AIDS and continues to practice is nothing better than a murderer.”

George Bergalis’s anger was understandable, but the intervening decades have shown it was misplaced. At the time, 19,000 patients of 57 other infected healthcare professionals were tested—none had caught the virus from their treatment. The risk of transfer of infection to a patient undergoing a highly invasive procedure (such as an open-heart transplant) from an infected doctor is around 1 in 5 million. That’s about the risk of being struck by lightning. The odds of one dentist infecting six people by accident are, therefore, ridiculous.

Acer might have infected his patients on purpose. A former colleague suggested a motive; Dr. Acer was angry that mainstream America struggled to care about HIV because it was seen as a disease that impacted homosexual men and drug addicts. The colleague says Acer told him, “when it starts affecting grandmothers and younger people, then you’ll see something done.” Yet this theory also has its own weaknesses: How could he have done it?

Almost the only plausible way that Acer could have done it is to have injected his own blood into patients. Yet contact with HIV-positive blood only passes on the infection only one time in 300 and none of his colleagues or patients ever noticed anything unusual. Acer would have only been able to pass on small amounts of his own fluids—his infection rate is high even if he was doing it on purpose. In addition, a review by the Federal General Accounting Office ordered by Congress found “no good evidence” that Acer made any effort to infect anyone.

So what could have happened? There are many theories. His strain of the disease may have been particularly virulent, or he may have had a particularly high viral load. Alternatively, he may not have caused the infections at all. An investigation by an insurance company called into question the CDC’s investigation, claiming that the patients all had alternative sources of infection risk. In a town of just 10,000 people, it’s not hard to imagine how a bunch of people could pass the disease among themselves. Those infected also had financial incentive in the form of compensation that may have altered their testimony.

Acer and most of his infected patients have since died. It seems likely we will never know whether it was an astonishing cluster of accidents, an ingenious murder plot or a whole lot of misplaced blame.

Show Me The Proof

HIV/AIDS: Four cases of transmission
UK Dept. of Health: Consultation on HIV positive healthcare workers launched
NY Times: AIDS and a Dentist’s Secrets