Vampire Facial is the colloquial name for cosmetic platelet-rich plasma microneedling facials. Seems like a benign procedure.

The Centers for Disease Control recently reported on multiple people who developed HIV infection tied to the procedure in New Mexico.

The details.

Investigation of a medical spa’s services began in 2018.

During summer 2018, the New Mexico Department of Health (NMDOH) was notified of a diagnosis of HIV infection in a woman with no known HIV risk factors who reported exposure to needles from cosmetic platelet-rich plasma microneedling facials (vampire facials) received at a spa in spring 2018. 

NMDOH and CDC identified four former spa clients, and one sexual partner of a spa client, all of whom received HIV infection diagnoses during 2018–2023, despite low reported behavioral risks associated with HIV acquisition. Nucleotide sequence analysis revealed highly similar HIV strains among all cases.

Patient #1 learned of her diagnosis in summer 2018 after receiving a positive rapid HIV test while abroad. She had a positive confirmatory test indicating stage I HIV infection. This patient apparently had no symptoms at the time of testing.

The patient reported no injection drug use, recent blood transfusions, or recent sexual contact with anyone other than her current sexual partner, who received a negative HIV test result after the patient’s diagnosis. However, the patient did report exposure to needles during a platelet-rich plasma (PRP) microneedling procedure in spring 2018 at a spa in New Mexico. The procedure involves drawing a client’s blood, separating the blood into its components of plasma and cells, and using single-use disposable or multiuse sterile equipment to inject the PRP into the face for cosmetic purposes, such as skin rejuvenation and reducing the appearance of acne scars.

In fall of 2018, the spa was closed. Tracking down prior patients was not easy.

The owner operated without appropriate licenses at multiple locations and did not have an appointment scheduling system that stored client contact information. Investigators compiled and cross-referenced names and telephone numbers from the spa’s client consent forms, handwritten appointment records, and telephone contacts to create a list of potentially affected clients.

The investigative team identified 59 clients at risk for exposure, including 20 who received PRP with microneedling at the spa, and 39 who received other injection services (e.g., onabotulinumtoxinA [botox]) during the case-finding period. Investigators cross-referenced the client list with the New Mexico state HIV registry and identified one spa client who received a diagnosis of HIV in 2012.

During 2018–2023, current and former spa clients who received new HIV diagnoses were reported to NMDOH from clinical providers throughout the state. During this period, a spa–related HIV case was defined as a new HIV diagnosis in a patient with previous receipt of blood product or any injection services provided by the spa’s owner from 2017 until closure of the unlicensed operation in fall 2018, or who had sexual contact with a person who received such spa services. Cases were included only if an HIV nucleotide sequence demonstrated molecular linkage to other HIV sequences from persons with infections associated with spa.

Four of the five patients with confirmed spa–related HIV infections received at least one PRP with microneedling facial treatment at the spa during May–September 2018. Two of the patients in this cluster (a man and a woman) were engaged in a sexual relationship before and after their diagnoses. Sexual partners of two other patients received negative HIV test results after their partners’ diagnoses, and the remaining patient reported having no sexual partner at the time of diagnosis. Before receiving a diagnosis of confirmed HIV infection, two of the five patients had previously received a positive rapid HIV test result during routine evaluations for life insurance, one in summer 2016, and the other in fall 2018; however, only one patient reported being notified of the positive screening test result and subsequently had their HIV diagnosis confirmed by a primary care provider in winter 2019. The other patient received a confirmed HIV diagnosis after hospitalization with an AIDS-defining illness in fall 2021. One patient received their HIV diagnosis in spring 2023 after hospitalization with an AIDS-defining illness.

The two patients who were engaged in a sexual relationship had stage 3 or chronic HIV infections, indicating that their infections were likely attributed to exposures before receipt of cosmetic injection services. The other three patients in this cluster had no known social contact with one another, and no specific mechanism for transmission among these patients was confirmed. Evidence suggests that contamination from an undetermined source at the spa during spring and summer 2018 resulted in HIV-1 transmission to these three patients.

Genetic analysis suggested a common source for the HIV infections.

The spa was investigated and found to be ignoring basic sterile procedures.

In fall 2018, on-site inspection of the spa revealed multiple unsafe infection control practices. A centrifuge, a heating dry bath, and a rack of unlabeled tubes containing blood were located on a kitchen counter. Unlabeled tubes of blood and medical injectables (i.e., botox and lidocaine) were stored in the kitchen refrigerator along with food. Unwrapped syringes were found in drawers, on counters, and discarded in regular trash cans. An autoclave (steam sterilizer) was not found on the premises. Procedure equipment was surface cleaned using ammonium chloride disinfecting spray and benzalkonium chloride disinfecting wipes after each client visit, and disposable electric desiccator tips were cleaned by alcohol immersion and reused.

Spanish was the first language of most patients – making it more challenging to complete the investigation.

NMDOH organized and advertised bloodborne pathogen testing events for current and former spa clients via social media, radio, newspaper, and television in both English and Spanish. Members of the NMDOH investigative team canvassed community health centers and businesses in predominantly Spanish-speaking neighborhoods to distribute testing information for current and former spa clients. As a result of these activities, 198 former spa clients and their sexual partners were tested during 2018–2023. No additional HIV infections were identified, nor were any hepatitis B or hepatitis C infections detected.

While the common thread for all infected patients was receipt of services at the spa (facial microneedling with PRP), the actual source of the contamination remains unknown.

In June 2022, the spa’s owner, Maria Ramos De Ruiz, pleaded guilty to five felony counts of practicing medicine without a license. She was sentenced to three-and-a-half years in prison. 

Not all seemingly benign procedures are risk-free. In fact, there are no risk-free procedures in medicine. The patients should not have sought care from unlicensed providers. But presumably, they assumed the provider was sufficiently qualified. This is a tough lesson for the patients and their families.

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