1
|
|
2
|
Lepage P, Van de Perre P. Nosocomial Transmission of HIV in Africa: What Tribute Is Paid to Contaminated Blood Transfusions and Medical Injections? Infect Control Hosp Epidemiol 2016. [DOI: 10.2307/30146444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AbstractWe reviewed the published data on the possible impact of medical injections and blood transfusions on the spread of human immunodeficiency virus (HIV) in Africa. We also compared these results to our experience in Rwanda, central Africa. The importance of medical injections in the epidemic of HIV infection seems to differ from one area to another. The excess of injections experienced by HIV seropositive subjects in Zaire could be secondary to the parenteral treatment of early HIV-related illness or to the treatment of sexually transmitted diseases, rather than being the cause of HIV infection, as suggested by Rwandese studies. In contrast, blood transfusions have been shown to represent an important source of nosocomial HIV infection in many African countries. Effective and relatively inexpensive measures to diminish the iatrogenic spread of HIV infection in developing countries are summarized.
Collapse
|
3
|
Gaines H, Albert J, Axelsson M, Berglund T, Gisslén M, Sönnerborg A, Blaxhult A, Bogdanovic G, Brytting M, Carlander C, Flamholc L, Follin P, Haggar A, Hagstam P, Johansson M, Navér L, Persson Blom J, Samuelson A, Ström H, Sundqvist M, Svedhem Johansson V, Tegmark Wisell K, Tegnell A, Thorstensson R. Six-week follow-up after HIV-1 exposure: a position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy. Infect Dis (Lond) 2015; 48:93-8. [PMID: 26414596 DOI: 10.3109/23744235.2015.1089593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 2014 the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy (RAV) conducted a review and analysis of the state of knowledge on the duration of follow-up after exposure to human immunodeficiency virus (HIV). Up until then a follow-up of 12 weeks after exposure had been recommended, but improved tests and new information on early diagnosis motivated a re-evaluation of the national recommendations by experts representing infectious diseases and microbiology, county medical officers, the RAV, the Public Health Agency, and other national authorities. Based on the current state of knowledge the Public Health Agency of Sweden and the RAV recommend, starting in April 2015, a follow-up period of 6 weeks after possible HIV-1 exposure, if HIV testing is performed using laboratory-based combination tests detecting both HIV antibody and antigen. If point-of-care rapid HIV tests are used, a follow-up period of 8 weeks is recommended, because currently available rapid tests have insufficient sensitivity for detection of HIV-1 antigen. A follow-up period of 12 weeks is recommended after a possible exposure for HIV-2, since presently used assays do not include HIV-2 antigens and only limited information is available on the development of HIV antibodies during early HIV-2 infection. If pre- or post-exposure prophylaxis is administered, the follow-up period is recommended to begin after completion of prophylaxis. Even if infection cannot be reliably excluded before the end of the recommended follow-up period, HIV testing should be performed at first contact for persons who seek such testing.
Collapse
Affiliation(s)
- Hans Gaines
- a Public Health Agency of Sweden , Solna .,b Unit of Infectious Diseases, Department of Medicine , Karolinska Institutet , Stockholm .,c Department of Infectious Diseases , Karolinska University Hospital , Stockholm
| | - Jan Albert
- d Department of Microbiology , Tumor and Cell Biology, Karolinska Institutet , Stockholm .,e Department of Clinical Microbiology , Karolinska University Hospital , Stockholm .,f Swedish Reference Group for Antiviral Therapy , Stockholm
| | | | | | - Magnus Gisslén
- f Swedish Reference Group for Antiviral Therapy , Stockholm .,g Department of Infectious Diseases , Sahlgrenska Academy, University of Gothenburg , Gothenburg
| | - Anders Sönnerborg
- c Department of Infectious Diseases , Karolinska University Hospital , Stockholm .,e Department of Clinical Microbiology , Karolinska University Hospital , Stockholm .,f Swedish Reference Group for Antiviral Therapy , Stockholm .,h Department of Laboratory Medicine, Division of Clinical Microbiology , Karolinska Institutet , Stockholm
| | - Anders Blaxhult
- i Department of Infectious Diseases , Södersjukhuset Venhälsan , Stockholm
| | - Gordana Bogdanovic
- e Department of Clinical Microbiology , Karolinska University Hospital , Stockholm
| | | | - Christina Carlander
- f Swedish Reference Group for Antiviral Therapy , Stockholm .,j Clinic of Infectious Diseases, County Hospital of Västmanland , Västerås
| | - Leo Flamholc
- f Swedish Reference Group for Antiviral Therapy , Stockholm .,k Department of Infectious Diseases , University of Lund, Skåne University Hospital , Malmö
| | - Per Follin
- l Department of Communicable Disease Control and Prevention , Region Västra Götaland , Gothenburg
| | - Axana Haggar
- m National Board of Health and Welfare , Stockholm
| | - Per Hagstam
- n Department of Communicable Disease Control and Prevention , Skåne , Malmö
| | - Marcus Johansson
- o Department of Clinical Microbiology and Infectious Diseases , Kalmar County Hospital , Kalmar
| | - Lars Navér
- f Swedish Reference Group for Antiviral Therapy , Stockholm .,p Department of Pediatrics , Karolinska University Hospital , Stockholm .,q Department of Clinical Science , Intervention and Technology, Karolinska Institute , Stockholm
| | | | - Agneta Samuelson
- e Department of Clinical Microbiology , Karolinska University Hospital , Stockholm
| | - Helena Ström
- m National Board of Health and Welfare , Stockholm
| | - Martin Sundqvist
- s Department of Laboratory Medicine , Clinical Microbiology, Örebro University Hospital , Örebro , Sweden
| | | | | | | | | |
Collapse
|
4
|
|
5
|
Abstract
The role nurses occupy in the care of the HIV/AIDS affected has evolved over time. This evolution is exhibited in the body of nursing knowledge and is recorded in the published literature. The purpose of this study was to describe landmarks in the evolution of nursing's involvement in the provision of care to HIV/AIDS patients and to examine the body of nursing knowledge relative to HIV/AIDS, employing bibliometric analytic techniques. It was expected that the literature would grow in both breadth and depth concurrent with nursing's increased role in caring for those infected, or at risk for infection, with HIV.
Collapse
Affiliation(s)
- J T Huber
- School of Library and Information Studies, Texas Woman's University, P. O. Box 425438, Denton, TX 76204-5438, USA
| | | | | |
Collapse
|
6
|
Abstract
Contemporary techno-scientific and medical developments are restructuring social interactions and the very processes by which individual subjectivity is formed. This essay elaborates on the experiential and ethical impact of such transformations from the perspective of people who, in ordinary and unexpected ways, act science and technology out. We carried out ethnographic research in an HIV/AIDS Testing and Counseling Center (CTA) in northeastern Brazil, combining participant observation with epidemiological analyses and clinical survey. We found a high demand for free testing by low-risk clients, largely working and middle class, experiencing anxiety and complaining of AIDS-like symptoms. Most of the clients were sero-negative and many returned for a second and third testing. We understand this to be a new techno-cultural phenomenon and call it imaginary AIDS. Throughout this essay, we describe CTA's routine practices, place these practices in historical, political, economic and cross-cultural perspective, and analyze the subjective data we collected from the clients of our pilot study. We explore how clinical epidemiological expertise and HIV testing technology are integrated into new forms of bio-politics aimed at specific marketable and disease-free populations, and on the affective absorption of bio-technical truth and the engendering of a technoneurosis in this testing center.
Collapse
Affiliation(s)
- J Biehl
- Department of Anthropology, Princeton University, New Jersey 08544-1011, USA
| | | | | |
Collapse
|
7
|
Pretty IA, Anderson GS, Sweet DJ. Human bites and the risk of human immunodeficiency virus transmission. Am J Forensic Med Pathol 1999; 20:232-9. [PMID: 10507789 DOI: 10.1097/00000433-199909000-00003] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The risk of human immunodeficiency virus (HIV) transmission following a bite injury is important to many groups of people. The first are those who are likely to be bitten as an occupational risk, such as police officers and institutional staff. Another group are represented by the victims and perpetrators of crimes involving biting, both in attack and defense situations. The possibility of these bites transmitting a potentially fatal disease is of interest to the physicians who treat such patients and the legal system which may have to deal with the repercussions of such a transmission. Bite injuries represent 1% of all emergency department admissions in the United States, and human bites are the third most common following those of dogs and cats. The worldwide epidemic of HIV and acquired immunodeficiency syndrome (AIDS) continues, with >5 million new cases last year and affecting 1 in 100 sexually active adults. A review of the literature concerning human bites, HIV and AIDS, HIV in saliva, and case examples was performed to examine the current opinion regarding the transmission of HIV via this route. A bite from an HIV-seropositive individual that breaks the skin or is associated with a previous injury carries a risk of infection for the bitten individual.
Collapse
Affiliation(s)
- I A Pretty
- Bureau of Legal Dentistry, University of British Columbia, Vancouver, Canada.
| | | | | |
Collapse
|
8
|
Abstract
This article describes the impact of the human immuno-deficiency virus (HIV) on clinical infertility practice. HIV is responsible for acquired immuno-deficiency syndrome (AIDS) and first became apparent in 1979, but was not fully recognised by clinicians and scientists until 1981. It is a new disease which now infects large numbers of humans, and there is the possibility that the virulence of the virus may change or mutations may render current testing strategies ineffective. For these reasons, it is important to have a cautious and flexible approach to minimise risk to infertile couples and to future children.
Collapse
Affiliation(s)
- T B Hargreave
- Fertility Problems Clinic, Department of Urology, Western General Hospital, Edinburgh, UK
| | | |
Collapse
|
9
|
Pendle S, Sacks LV. Primary HIV infection diagnosed in South Africa masquerading as another tropical disease. Trans R Soc Trop Med Hyg 1998; 92:425-7. [PMID: 9850399 DOI: 10.1016/s0035-9203(98)91078-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Eleven patients referred to a hospital in South Africa with suspected tropical diseases such as malaria, typhoid fever and South African tick bite fever were found to be suffering from primary human immunodeficiency virus (HIV) infection. Hospital records were reviewed retrospectively in those acutely ill, febrile patients where a clinical suspicion of HIV seroconversion existed and no other diagnosis could be found. A history of recent travel, particularly to malarious areas, was given by most of these patients. The clinical presentation was dominated by high fevers and headaches. The most helpful pointers to primary HIV infection included a characteristic palatal enanthem, leucopenia and thrombocytopenia. Ironically, the history of recent travel appeared to have confounded the diagnosis despite the fact that travel has often been associated with the acquisition of HIV in Africa. Recognition of primary HIV infection masquerading as a tropical disease may result in more frequent diagnosis of this serious condition.
Collapse
Affiliation(s)
- S Pendle
- Rietfontein Tropical Diseases Hospital, Sandringham, South Africa
| | | |
Collapse
|
10
|
Payne-James JJ, Keys DW, Wall I, Dean PJ. Prevalence of HIV risk factors for individuals examined in clinical forensic medicine. ACTA ACUST UNITED AC 1994; 1:93-6. [PMID: 16371274 DOI: 10.1016/1353-1131(94)90007-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE to identify the prevalence of high-risk factors for infection with Human Immunodeficiency Virus (HIV) in individuals examined in clinical forensic medical practice and to determine opinions and attitudes about HIV in this patient group. DESIGN Anonymised questionnaire completed by consecutive individuals seen in clinical forensic medical practice. SETTING Police stations in London attended by Group IV forensic medical examiners. SUBJECTS 518 individuals examined in police stations (including prisoners and suspects, those detained in police custody, police officers and victims of crime). RESULTS 164 (31.7%) individuals did not respond to the questionnaire because of: 1) refusal (12.6%) 2) inability because of drugs and/or alcohol (11.4%) 3) mental illness/disorder (4.2%) or 4) language difficulties (3.5%). 28.4% of the respondents were in at least one of the 'high-risk' categories for HIV infection. 26.5% were intravenous drug misusers; 15% were prostitutes; 9.8% (or their sexual partners) had lived in Central or East Africa since 1977; 5.9% were male homosexuals and 0.5% were haemophiliacs. 5.1% were infected with HIV or had Acquired Immunodeficiency Syndrome (AIDS). Only 28.8% of individuals always used condoms in short-term sexual relationships. 44.4% of respondents believed that everyone should be tested for HIV. CONCLUSION Over one-quarter of the respondents were in higher-risk groups for infection with HIV. Almost one-third could or would not respond. It is concluded that it is not possible to identify by questionnaire, individuals at higher risk of HIV infection in forensic medical practice. This reinforces the necessity of observing good clinical practice to reduce contamination risks in this work environment. It is clear that education about risks for HIV infection is still much needed.
Collapse
Affiliation(s)
- J J Payne-James
- Forensic Medical Research Group, PO Box 3525, Victoria Park, London E9 7UB, UK
| | | | | | | |
Collapse
|
11
|
Abstract
OBJECTIVE To review the risk of HIV infection following occupational exposure, the theoretical basis for chemoprophylaxis, investigative experience with chemoprophylaxis in animals and humans, and the economic aspects of postexposure chemoprophylaxis. DATA SOURCES English-language articles and conference proceedings pertaining to the risk of occupational HIV infection and to postexposure chemoprophylaxis. STUDY SELECTION Studies evaluating chemoprophylaxis of HIV infection following occupational exposure were selected for review. Abstracts reporting ongoing clinical trials were also included. DATA EXTRACTION In vitro studies are discussed to provide the immunologic rationale for chemoprophylaxis. Animal studies examining the efficacy of chemoprophylaxis in preventing non-HIV retroviral infection are reviewed, and their applicability to human HIV infection is critically evaluated. Human studies and case reports describing attempts at chemoprophylaxis of HIV infection following occupational exposure are discussed. DATA SYNTHESIS Chemoprophylaxis of HIV infection following occupational exposure has focused on the use of zidovudine (ZDV) because it was previously the only antiretroviral agent approved for treating HIV infection. Animal models of retroviral infection provide conflicting data regarding the efficacy of ZDV chemoprophylaxis, and there are important questions about the applicability of animal data to human HIV infection because of differences in natural histories of non-HIV retroviral infections, inoculum size, dosing of ZDV, and routes of infection. Human surveillance studies are thus far inadequate to determine the efficacy of ZDV prophylaxis because of the very low HIV seroconversion rates following occupational exposure. ZDV is well tolerated during short-term administration in people without HIV infection, but long-term safety is unknown. In addition, the true cost-benefit ratio of ZDV chemoprophylaxis is uncertain. CONCLUSIONS Current data from in vitro, animal, and human studies are inadequate to define the appropriate role of ZDV in preventing HIV infection following occupational exposure. Limited toxicity data and the high cost of treatment must be weighed against the theoretical benefits of ZDV use in this setting. The decision to employ ZDV for postexposure prophylaxis must ultimately be based on existing institutional policies, the attitude of the responsible physician regarding such practice, and/or the desires of the exposed healthcare worker after being properly informed of potential risks and benefits.
Collapse
Affiliation(s)
- D N Fish
- Division of Pharmacy Practice, School of Pharmacy, University of Colorado Health Sciences Center, Denver 80262
| |
Collapse
|
12
|
Manifestations cliniques et biologiques de la primo-infection par le virus de l'immunodéficience humaine : revue de la littérature. Med Mal Infect 1993. [DOI: 10.1016/s0399-077x(05)81191-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
13
|
Machado AA, da Costa JC, Gir E, Moriya TM, Figueiredo JF. [Risk of infections by the human immunodeficiency virus (HIV) among health professionals]. Rev Saude Publica 1992; 26:54-6. [PMID: 1307422 DOI: 10.1590/s0034-89101992000100010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To investigate the occupational risk of infection by HIV among health professionals, 36 cases of occupational accidents involving exposure to material potentially infected with HIV, reported at a Brazilian General Hospital (HCFMRP), were studied. Of the injured workers 75% were female and 25% male (ranging from 23 to 49 years old) and just one of them had high-risk behavior of HIV infection. Of these health professionals, 52.8% were nursing auxiliaries, 19.4%, nurses, 13.9%, nursing attendants, 5.5%, laboratory technicians, 2.8% surgery instrumentalist, 2.8% accountants and 2.8% nursing technicians. In 47.2% of cases the workers had a parenteral exposure to blood (needlestick injuries). The right hand and fingers were the body areas most effected. The serologic test to detect HIV antibodies by the ELISA method was required of all the workers. The results were negative and no seroconversion was registered during the one year follow-up period. The professionals were retested one month, 2 months, 6 months and one year after the exposure. In conclusion, the risk of infection by HIV among health professionals of HCFMRP seems to be very low. Continuing education should be provided for health care workers with a view to reinforcing the use of universal precaution, especially those to prevent injuries caused by needles or other sharp instruments.
Collapse
Affiliation(s)
- A A Machado
- Departamento de Clínica Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Brasil
| | | | | | | | | |
Collapse
|
14
|
Go GW, Baraff LJ, Schriger DL. Management guidelines for health care workers exposed to blood and body fluids. Ann Emerg Med 1991; 20:1341-50. [PMID: 1746739 DOI: 10.1016/s0196-0644(05)81078-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The purpose of this article is to propose specific management guidelines for the immediate emergency department and subsequent occupational health treatment of health care workers (HCWs) following accidental exposures to blood or body fluids. These guidelines are based on a collective review of the literature and the recommendations of the Advisory Committee on Immunization Practices (ACIP) and authorities expert in this knowledge domain. Guidelines are needed to assure appropriate treatment and coordinated efforts by ED and occupational health providers. Although numerous infections can potentially be transmitted by exposure to blood and body fluids, these guidelines are intended only for evaluation and postexposure prophylaxis of hepatitis B, hepatitis C, and infection with HIV.
Collapse
Affiliation(s)
- G W Go
- Emergency Medicine Center, UCLA School of Medicine
| | | | | |
Collapse
|
15
|
Ortiz R, Aaberg TM. Human immunodeficiency virus disease epidemiology and nosocomial infection. Am J Ophthalmol 1991; 112:335-42. [PMID: 1882946 DOI: 10.1016/s0002-9394(14)76737-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R Ortiz
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA
| | | |
Collapse
|
16
|
Cavalcante NJ, Abreu ES, Fernandes ME, Richtmann R, Piovesana MN, Yamada FT, Carvalho ES. Risk of health care professionals acquiring HIV infection in Latin America. AIDS Care 1991; 3:311-6. [PMID: 1932195 DOI: 10.1080/09540129108253078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study describes the professional risk of acquiring HIV infection while caring for AIDS patients at a teaching hospital in Brazil. Since 1985 we have tested health care professionals (HCP) for HIV-1 antibody after accidents with blood and body fluids from AIDS patients. The blood samples were tested twice using an ELISA FDA approved test and, if positive, we performed Western blot. Two hundred and forty seven health care professionals reported 338 accidents (50% were percutaneous and 22% were mucous membrane exposures to blood). A further 404 HCPs reported no occupational exposure but wanted to be tested. From 247 HCPs with at least one accident, we analyzed 115 with more than 6 months of follow up. None were HIV antibody positive. Nobody received zidovudine as a prophylaxis. Of the 404 HCPs with no accident, 6 (1.5%) were positive and had confirmed risk factors for HIV. Our results support other studies that report a low occupational risk (about 0.4%) of acquiring HIV infection.
Collapse
|
17
|
Kirchhoff F, Voss G, Nick S, Stahl-Hennig C, Coulibaly C, Frank R, Jentsch KD, Hunsmann G. Antibody response to the negative regulatory factor (nef) in experimentally infected macaques: correlation with viremia, disease progression, and seroconversion to structural viral proteins. Virology 1991; 183:267-72. [PMID: 1675823 DOI: 10.1016/0042-6822(91)90139-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The antibody response to structural and regulatory viral proteins was studied in 14 rhesus (Macaca mulatta) and 6 cynomolgus (Macaca fascicularis) macaques experimentally infected with HIV-2 or SIVMAC. To investigate the humoral antibody response to the negative regulatory factor (nef), the recombinant protein was expressed to high levels with recombinant vaccinia virus (VV). nef-specific antibodies were detected in 14 of 20 infected macaques (70%). In sera of all infected monkeys antibodies directed to the structural proteins gp120, p56, and p24 appeared 2 to 6 weeks postinfection. In contrast, the extent and the appearance of nef-specific antibodies during the course of infection varied considerably between individual animals. However, only in sera of four animals (20%) were nef-specific antibodies detectable as early as those against the core proteins p24 and p56. In SIVMAC-infected rhesus macaques at different clinical stages, the antibody response towards nef neither correlated with the development of viral latency nor to disease progression or viremia. Our data indicate that in macaques experimentally infected with SIV or HIV-2 antibody formation against nef is not a useful diagnostic marker either for early detection of viral infection or of disease progression.
Collapse
Affiliation(s)
- F Kirchhoff
- German Primate Centre, Department of Virology and Immunology, Göttingen
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Clark SJ, Saag MS, Decker WD, Campbell-Hill S, Roberson JL, Veldkamp PJ, Kappes JC, Hahn BH, Shaw GM. High titers of cytopathic virus in plasma of patients with symptomatic primary HIV-1 infection. N Engl J Med 1991; 324:954-60. [PMID: 1900576 DOI: 10.1056/nejm199104043241404] [Citation(s) in RCA: 413] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Primary infection with the human immunodeficiency virus (HIV-1) frequently causes an acute, self-limited viral syndrome. To examine the relations among viral replication, the immune response of the host, and clinical illness during this initial phase of infection, we undertook a quantitative, molecular, and biologic analysis of infectious HIV-1 in the blood and plasma of three patients with symptomatic primary infection and of a sexual partner of one of them. METHODS During an eight-week period of primary infection, HIV-1 was cultured frequently in dilutions of plasma and peripheral-blood mononuclear cells (PBMC), and levels of HIV-1 antigen and antibody were determined sequentially by enzyme-linked immunosorbent assay and immunoblotting. Replication-competent HIV-1 proviruses were cloned and characterized biologically. RESULTS Six to 15 days after the onset of symptoms, high titers of infectious HIV-1 (from 10 to 10(3) tissue-culture-infective doses per milliliter of plasma) and viral p24 antigen were detected in the plasma of all three patients. These titers fell precipitously by day 27, and the decline coincided with an increase in the levels of antiviral antibodies and the resolution of symptoms. Sequential isolates of virus from plasma and PBMC obtained throughout the period of primary infection, as well as virus derived from two molecular proviral clones, were highly cytopathic for normal-donor PBMC and immortalized T cells, despite the marked reduction in the titers of virus in plasma. CONCLUSIONS Primary, symptomatic HIV-1 infection is associated with high titers of cytopathic, replication-competent viral strains, and during such infection potential infectivity is enhanced. Effective control of HIV-1 replication during primary infection implies the activation of clinically important mechanisms of immune defense that merit further examination in relation to the development of antiviral therapy and vaccines.
Collapse
Affiliation(s)
- S J Clark
- Department of Medicine, University of Alabama, Birmingham 35294
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Anderson DC, Blower AL, Packer JM, Ganguli LA. Preventing needlestick injuries. BMJ (CLINICAL RESEARCH ED.) 1991; 302:769-70. [PMID: 2043216 PMCID: PMC1669550 DOI: 10.1136/bmj.302.6779.769] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
20
|
DeVries JE, Burnette MM, Redmon WK. AIDS prevention: improving nurses' compliance with glove wearing through performance feedback. J Appl Behav Anal 1991; 24:705-11. [PMID: 1797773 PMCID: PMC1279627 DOI: 10.1901/jaba.1991.24-705] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A performance feedback procedure was used to increase glove wearing by nurses in a hospital emergency room in situations in which contact with body fluids was highly likely. Infection-control nurses provided biweekly performance feedback to staff nurses on an individual private basis to inform them of the percentage of contact opportunities in which they wore gloves. Observations made prior to (baseline) and during feedback in a multiple baseline design across 4 subjects indicated that substantial increases in glove wearing in target situations occurred after implementation of the feedback program and that increases occurred across most of the specific situations in which glove wearing was advised. Percentage increases in glove wearing ranged from 22% to 49% across subjects. The results are discussed in terms of prevention of acquired immune deficiency syndrome (AIDS) by use of universal precautions.
Collapse
Affiliation(s)
- J E DeVries
- Western Michigan University, Kalamazoo 49008-5052
| | | | | |
Collapse
|
21
|
Abstract
OBJECTIVE To assess the frequency and causes of needlestick injuries in medical and surgical housestaff. DESIGN A retrospective survey. SETTING Urban university teaching hospital. PARTICIPANTS 386 housestaff; 221 responded. INTERVENTION Survey questionnaire. MAIN RESULTS 1) Frequency of needlestick: Of 221 respondents, 57 (26%) reported never having had a needlestick, while 164 (74%) reported at least one needlestick injury with a suture or hollow-bore needle. The average frequencies were 0.63 per resident-year among 149 non-surgical residents and 3.8 per resident-year among 72 surgical residents. Among residents in internal medicine, 12 of 78 needlestick injuries (15%) sustained were from patients documented to be HIV-positive. 2) Causes of needlestick: The causes of injury were assessed in detail in a sample of the 157 most recent needlestick injuries. Suturing was the cause in 35 of 61 (57%) surgical residents, while recapping needles was the cause in 36 of 96 (38%) non-surgical residents. Inexperience was not the cause of injury; in 94% of cases the residents felt comfortable performing the procedure, and in 74% of cases the residents had performed the procedure more than 50 times before. 3) Reporting of injury: Only 30 (19%) of 157 injuries were reported to the personnel health service, thus compromising documentation for potential workmen's compensation. CONCLUSIONS Needlestick injuries are common among medical and surgical housestaff. Efforts should be made to prevent needlestick injuries and to report those that occur.
Collapse
Affiliation(s)
- A E Heald
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510-8025
| | | |
Collapse
|
22
|
Boiocchi M, Carbone A, De Re V, Dolcetti R, Volpe R, Tirelli U. AIDS-related B-cell non-Hodgkin's lymphomas in direct blood-stream HIV-infected patients: pathogenesis and differentiation features. Int J Cancer 1990; 45:883-8. [PMID: 2159439 DOI: 10.1002/ijc.2910450518] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Six AIDS-related NHLs from direct blood-stream HIV-infected patients were characterized for clonality, maturation cell characteristics, activation of c-myc proto-oncogene and presence of HIV and EBV genomes. Four out of the 6 AIDS-related NHLs were of immature B-cell origin, contrasting with the lower frequency (2 out of 31) of immature B-cell NHLs occurring in HIV-negative patients. Moreover, 3 out of the 4 AIDS-related pre-B-NHLs were extranodal lymphomas. C-myc translocations or rearrangements were not found in Italian AIDS-related NHLs, unlike c-myc activation which had a high prevalence in the American series of AIDS-related NHLs. HIV and EBV are not, or only occasionally, directly involved in AIDS-related NHL pathogenesis since HIV genome has never been found in the neoplastic clones and EBV genome was detected in only 1 out of the 6 lymphomas analyzed.
Collapse
Affiliation(s)
- M Boiocchi
- Division of Experimental Oncology I, Centro di Riferimento Oncologico, Aviano, Italy
| | | | | | | | | | | |
Collapse
|
23
|
Gottesman LG, Miles AJ, Milsom JW, Northover JM, Schecter WP, Stotter A. The management of anorectal disease in HIV-positive patients. Int J Colorectal Dis 1990; 5:61-72. [PMID: 2358739 DOI: 10.1007/bf00298471] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- L G Gottesman
- Department of Surgery, Westminster Hospital, London, UK
| | | | | | | | | | | |
Collapse
|
24
|
Kelen GD. Human immunodeficiency virus and the emergency department: risks and risk protection for health care providers. Ann Emerg Med 1990; 19:242-8. [PMID: 2155551 DOI: 10.1016/s0196-0644(05)82037-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The AIDS epidemic is having an increasing impact on the practice of emergency medicine. In inner-city emergency departments, significant numbers of patients have unrecognized human immunodeficiency virus (HIV) infection. Transmission of HIV in the health care setting has been predominantly from exposure to patients' infected blood, but most of the exposures (80%) are due to injuries from sharp instruments. There are only 18 documented cases of occupational HIV transmission worldwide. Four of these have occurred from nonparenteral exposures. Based on surveillance studies, the best estimate of seroconversion after exposure is about 0.5%. However, due to methodologic limitations, these figures may be underestimations. The effectiveness of azidothymidine for postexposure prophylaxis has not been shown. Currently, the best protection against HIV and other blood-borne pathogens remains use of universal precautions.
Collapse
Affiliation(s)
- G D Kelen
- Division of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
25
|
Isgar B, Turner AG. Staff safety and bladder irrigation. BRITISH JOURNAL OF UROLOGY 1989; 64:657. [PMID: 2627647 DOI: 10.1111/j.1464-410x.1989.tb05337.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- B Isgar
- Department of Urology, Edith Cavell Hospital, Peterborough
| | | |
Collapse
|
26
|
Gerberding JL. Risks to Health Care Workers from Occupational Exposure to Hepatitis B Virus, Human Immunodeficiency Virus, and Cytomegalovirus. Infect Dis Clin North Am 1989. [DOI: 10.1016/s0891-5520(20)30305-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
27
|
Gerner HM, Ivey FD, Lane TW. Follow-up and education of employees exposed to a patient with HIV antibodies and massive bleeding. Am J Infect Control 1989; 17:349-52. [PMID: 2596733 DOI: 10.1016/0196-6553(89)90005-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- H M Gerner
- Moses H. Cone Memorial Hospital, Greensboro, NC 27401-1020
| | | | | |
Collapse
|
28
|
Kelleher JP, Crofton ME, Witherow RO. Temporary upper tract urinary diversion using a detachable occlusion balloon and percutaneous nephrostomy. BRITISH JOURNAL OF UROLOGY 1989; 64:657-8. [PMID: 2627648 DOI: 10.1111/j.1464-410x.1989.tb05338.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- J P Kelleher
- Department of Urology, St Mary's Hospital, London
| | | | | |
Collapse
|
29
|
|
30
|
Horsburgh CR, Ou CY, Jason J, Holmberg SD, Longini IM, Schable C, Mayer KH, Lifson AR, Schochetman G, Ward JW. Duration of human immunodeficiency virus infection before detection of antibody. Lancet 1989; 2:637-40. [PMID: 2570898 DOI: 10.1016/s0140-6736(89)90892-1] [Citation(s) in RCA: 214] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To estimate the duration and frequency of the period of HIV infection without detectable antibody, modelling techniques were applied to results of detection of HIV DNA by means of the polymerase chain reaction (PCR) and to data from cases in published reports. PCR was carried out with gag and env region primers on samples from 27 homosexual and 12 haemophilic men for whom stored samples were available from before and after seroconversion; serum was also tested for p24 antigen by antigen-capture enzyme immunoassay. HIV DNA was detectable before seroconversion in 4 men; in all 4 PCR was positive only in the seronegative sample taken closest to the time of seroconversion. In 3 men antigen was detected before seroconversion; in each case HIV DNA was also detected. By a Markov model, the time from infection with HIV (as assessed by detection of HIV DNA) to first detection of HIV antibody was estimated to be 2.4 (SE 2.1) months for the median individual. Modelling of cases of HIV infection with known exposure in published reports gave a median estimate of 2.1 (0.1) months from exposure to antibody detection, and 95% of cases would be expected to seroconvert within 5.8 (0.6) months. HIV infection for longer than 6 months without detectable antibody seems uncommon.
Collapse
Affiliation(s)
- C R Horsburgh
- AIDS Program, Centers for Disease Control, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Abstract
Intraoperative perforation of surgical gloves is common. Nine hundred and forty surgical gloves were tested after 100 consecutive plastic surgical operations, each involving a surgeon, a variable number of assistants and a scrub nurse. In the first 52 operations, single gloves were used and 21.5% of the staff were found to have a perforated glove. In the second 48 operations, double gloves were used by all members of the surgical team and the number with perforations (of both inner and outer gloves) was reduced to 9%. Most perforations occurred on the dorsum of the hand and fingers and on the thumb tip, especially in the non-dominant hand. The risk of acquiring AIDS due to glove perforation is low but the consequences of such an event could be lethal.
Collapse
Affiliation(s)
- R P Cole
- Department of Plastic Surgery, St Thomas's Hospital, London
| | | |
Collapse
|
32
|
Imagawa DT, Lee MH, Wolinsky SM, Sano K, Morales F, Kwok S, Sninsky JJ, Nishanian PG, Giorgi J, Fahey JL. Human immunodeficiency virus type 1 infection in homosexual men who remain seronegative for prolonged periods. N Engl J Med 1989; 320:1458-62. [PMID: 2716797 DOI: 10.1056/nejm198906013202205] [Citation(s) in RCA: 331] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Infection with the human immunodeficiency virus type 1 (HIV-1), as demonstrated by viral cultures, has been described in some patients before antibodies to HIV-1 can be detected, but the duration and frequency of such latent infections are uncertain. We selected prospectively a cohort of 133 seronegative homosexual men who continued to be involved in high-risk sexual activity, and we cultured 225 samples of their peripheral-blood lymphocytes, using mitogen stimulation to activate the integrated HIV-1 genome. HIV-1 was isolated in blood samples from 31 of the 133 men (23 percent), 27 of whom have remained seronegative for up to 36 months after the positive culture. The other four men seroconverted 11 to 17 months after the isolation of HIV-1. In three of them, we studied cryopreserved lymphocytes obtained earlier, using the polymerase chain reaction to amplify small amounts of viral DNA, and we demonstrated that HIV-1 provirus had been present 23, 35, and 35 months before seroconversion. We conclude that HIV-1 infection in homosexual men at high risk may occur at least 35 months before antibodies to HIV-1 can be detected. A prolonged period of latency in such infections may be more common than previously recognized; the degree of infectiousness during such periods is unknown.
Collapse
Affiliation(s)
- D T Imagawa
- Department of Pediatrics, University of California at Los Angeles, School of Medicine, Torrance 90509
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ameisen JC, Guy B, Chamaret S, Loche M, Mouton Y, Neyrinck JL, Khalife J, Leprevost C, Beaucaire G, Boutillon C. Antibodies to the nef protein and to nef peptides in HIV-1-infected seronegative individuals. AIDS Res Hum Retroviruses 1989; 5:279-91. [PMID: 2786420 DOI: 10.1089/aid.1989.5.279] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The silent period that follows infection by the human immunodeficiency virus (HIV-1) and precedes seroconversion remains a problem for the screening of blood supply, and knowledge about the mechanism involved in the maintenance of latency is only fragmentary. Using purified nef recombinant protein and six synthetic nef peptides, antibodies to the product of an HIV-1 regulatory gene, the negative regulatory factor (nef) involved in maintenance of proviral latency, were detected by Western blot and radioimmunoassay techniques in HIV-1-seronegative, viral antigen-negative, and virus culture-negative individuals at risk for HIV infection. This antibody response to nef was correlated in eight individuals with the detection of HIV-1 proviral DNA by oligonucleotide hybridization, following enzymatic amplification of HIV DNA in peripheral blood mononuclear cells. Such latent HIV infections have now been followed for up to 6 or 10 months in five individuals. In addition, retrospective and prospective analysis of HIV-1-seropositive individuals have shown (1) antibodies to nef preceding seroconversion, and (2) the persistence of antibodies to nef and of HIV-1 proviral DNA in a case of spontaneous complete HIV-1 seronegativation. Since DNA amplification cannot be currently considered for routine use, screening for anti-nef antibodies followed by confirmation by DNA amplification could represent a basis for new diagnostic strategies. Beyond their diagnostic implications, these findings, suggesting that regulatory genes of the HIV-1 provirus can be expressed prior to the initiation of virion synthesis, may also be applicable in the design of alternative vaccines against the acquired immunodeficiency syndrome.
Collapse
Affiliation(s)
- J C Ameisen
- Centre d'Immunologie et de Biologie Parasitaire, INSERM U 167-CNRS 624, Institut Pasteur, Lille, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Hruza GJ, Snow SN. Basal cell carcinoma in a patient with acquired immunodeficiency syndrome: treatment with Mohs micrographic surgery fixed-tissue technique. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1989; 15:545-51. [PMID: 2654234 DOI: 10.1111/j.1524-4725.1989.tb03415.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A case illustrating Mohs micrographic surgery fixed-tissue technique in the treatment of a large basal cell carcinoma of the left nasal alar groove in a patient with acquired immunodeficiency syndrome is described. Fixation of the tissue before excision and appropriate infectious disease precautions minimize exposure to the human immunodeficiency virus by the surgical and laboratory personnel, while Mohs micrographic mapping assures complete removal of a potentially life-threatening cancer in an immunocompromised patient.
Collapse
Affiliation(s)
- G J Hruza
- Cutaneous Surgery Center, Barnes Hospital, Washington University Medical Center, St. Louis, Missouri
| | | |
Collapse
|
35
|
|
36
|
Affiliation(s)
- L R Shirley
- Department of Pediatrics, Medical University of South Carolina, Charleston 29425
| | | |
Collapse
|
37
|
Johnson CD, Evans R, Shanson DC, Wastell C. Attitudes of operating theatre staff to inoculation-risk cases. Br J Surg 1989; 76:195-7. [PMID: 2702457 DOI: 10.1002/bjs.1800760229] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In a 12-month period, 177 patients at risk of infection with human immunodeficiency virus (HIV) or hepatitis B were operated on. Sixty-nine had HIV antibodies. The procedures used to identify these patients and minimize the risk of infection of hospital staff in the operating department are described. All staff working in the operating department were surveyed to determine their caseload, feelings of anxiety, and the incidence of high-risk exposure to infection. Anxiety was not related to workload, but was more common in those who had high-risk exposure. All members of staff who sustained a needlestick injury were tested for HIV antibodies at intervals after injury; 33 also volunteered to be tested in a screening session 3 months after the study period. None had HIV antibodies, suggesting that the risk of acquiring HIV infection in the operating department is low.
Collapse
Affiliation(s)
- C D Johnson
- Department of Surgery, St. Stephen's Hospital, London, UK
| | | | | | | |
Collapse
|
38
|
Abstract
The decision to operate on carriers of the human immunodeficiency virus (HIV) who need an urgent cardiac operation is difficult. There is a lack of knowledge about the effect of the presence of HIV on operative risk, about the effect of cardiopulmonary bypass on the progression of HIV infection to acquired immunodeficiency syndrome (AIDS), and about the risk to the cardiac surgical team of operating on 1 or more HIV carriers. This lack of knowledge is exacerbated by the strict regulations surrounding testing. We polled the board-certified cardiac surgeons in the United States on their willingness to perform open cardiac procedures on HIV carriers and AIDS patients. Fifty-three percent of the surgeons responded. Two thirds of them will operate on HIV carriers who need an urgent cardiac operation but regard the presence of AIDS as a contraindication to cardiopulmonary bypass. This is presumably a medical judgment. Those who will not operate on HIV carriers are apparently motivated by fear rather than moral judgments concerning the patients. Virtually all surgeons want to be able to test "high-risk" patients, and a substantial majority would test all patients.
Collapse
Affiliation(s)
- D Condit
- Albert Einstein College of Medicine, Bronx, New York
| | | |
Collapse
|
39
|
Goldwater PN, Law R, Nixon AD, Officer JA, Cleland JF. Impact of a Recapping Device on Venepuncture-Related Needlestick Injury. Infect Control Hosp Epidemiol 1989. [DOI: 10.2307/30145176] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
40
|
McMahon KM. The Integration of HIV Testing and Counseling into Nursing Practice. Nurs Clin North Am 1988. [DOI: 10.1016/s0029-6465(22)01438-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
41
|
Gaines H. Primary HIV infection. Clinical and diagnostic aspects. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES. SUPPLEMENTUM 1988; 61:1-46. [PMID: 2814368 DOI: 10.3109/inf.1988.20.suppl-61.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- H Gaines
- Department of Infectious Diseases, Karolinska Institute, Roslagstull Hospital, Stockholm, Sweden
| |
Collapse
|
42
|
|
43
|
Gaines H, von Sydow M, Pehrson PO, Lundbegh P. Clinical picture of primary HIV infection presenting as a glandular-fever-like illness. BMJ (CLINICAL RESEARCH ED.) 1988; 297:1363-8. [PMID: 3146367 PMCID: PMC1835053 DOI: 10.1136/bmj.297.6660.1363] [Citation(s) in RCA: 94] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The clinical symptoms and signs were assessed in 20 consecutive patients developing infection with the human immunodeficiency virus (HIV). All were male homosexuals and all presented with a glandular-fever-like illness. Changes in laboratory values were compared with findings in 40 HIV negative male homosexual controls. In the 10 patients for whom date of exposure to the virus could be established the incubation period was 11-28 days (median 14). One or two days after the sudden onset of fever patients developed sore throat, lymphadenopathy, rash, lethargy, coated tongue, tonsillar hypertrophy, dry cough, headache, myalgia, conjunctivitis, vomiting, night sweats, nausea, diarrhoea, and palatal enanthema. Twelve patients had painful, shallow ulcers in the mouth or on the genitals or anus or as manifested by oesophageal symptoms; these ulcers may have been the site of entry of the virus. During the first week after the onset of symptoms mild leucopenia, thrombocytopenia, and increased numbers of banded neutrophils were detected (p less than 0.0005). The mean duration of acute illness was 12.7 days (range 5-44). All patients remained healthy during a mean follow up period of 2.5 years. Heightened awareness of the typical clinical picture in patients developing primary HIV infection will alert the physician at an early stage and so aid prompt diagnosis and help contain the epidemic spread of AIDS.
Collapse
Affiliation(s)
- H Gaines
- Department of Infectious Disease, Roslagstull Hospital, Karolinska Institute, Stockholm, Sweden
| | | | | | | |
Collapse
|
44
|
Marcus R. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med 1988; 319:1118-23. [PMID: 3273755 DOI: 10.1056/nejm198810273191703] [Citation(s) in RCA: 375] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Since 1983, we have conducted national surveillance of health care workers exposed to blood or body fluids from persons infected with the human immunodeficiency virus (HIV), to assess the risk of HIV transmission by such exposures. As of July 31, 1988, 1201 health care workers with blood exposures had been examined, including 751 nurses (63 percent), 164 physicians and medical students (14 percent), 134 laboratory workers (11 percent), and 90 phlebotomists (7 percent). The exposures resulted from needle-stick injuries (80 percent), cuts with sharp objects (8 percent), open-wound contamination (7 percent), and mucous-membrane exposure (5 percent). We concluded that 37 percent of the exposures might have been prevented. Of 963 health care workers whose serum has been tested for HIV antibody at least 180 days after exposure, 4 were positive, yielding a seroprevalence rate of 0.42 percent (upper limit of 95 percent confidence interval, 0.95 percent). Three subjects experienced an acute retroviral syndrome associated with documented seroconversion; serum collected within 30 days of exposure was not available from the fourth person. Two exposures that resulted in seroconversion were caused by coworkers during resuscitation procedures. We conclude that the risk of HIV infection after exposure to the blood of a patient infected with HIV is low, but at least six months of follow-up is recommended. Many exposures can be prevented by careful adherence to existing infection-control precautions, even during emergencies.
Collapse
Affiliation(s)
- R Marcus
- Hospital Infections Program, Centers for Disease Control, Atlanta, GA 30333
| |
Collapse
|
45
|
Position statement. Prevention of transmission of blood-borne infectious agents during blood glucose monitoring. DIABETES EDUCATOR 1988; 14:425-6. [PMID: 3203613 DOI: 10.1177/014572178801400514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
46
|
Kelen GD, Fritz S, Qaqish B, Brookmeyer R, Baker JL, Kline RL, Cuddy RM, Goessel TK, Floccare D, Williams KA. Unrecognized human immunodeficiency virus infection in emergency department patients. N Engl J Med 1988; 318:1645-50. [PMID: 3163774 DOI: 10.1056/nejm198806233182503] [Citation(s) in RCA: 221] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To determine the extent of unrecognized human immunodeficiency virus (HIV) infection, we examined blood samples drawn from patients presenting to an inner-city emergency department. We found 119 of 2302 consecutive adult patients (5.2 percent) to be seropositive for HIV. Although 27 patients presented with known symptomatic HIV infection, 92 of the remaining 2275 patients (4.0 percent) had unrecognized HIV infection. The highest seroprevalence rate (11.4 percent) was found among black men 30 to 34 years of age. Blacks, other nonwhites, and patients under the age of 45 had high rates of unrecognized infection. The clinical team established risk-factor status in only 29.0 percent of the patients. Of the 276 patients with identified risk factors, 13.0 percent were seropositive, whereas 3.1 percent of the 1616 patients with unknown risk-factor status were seropositive. None of the 102 patients who reported no risk factors were seropositive. Although penetrating trauma (seroprevalence, 13.6 percent) was the only clinical presentation associated with an increased seroprevalence rate independent of other known predictors of infection (P = 0.02), seropositive patients were found in all categories of clinical condition. These data, although based on observations in one emergency department setting, support the concept of universal blood and body-fluid precautions by all health care workers whether or not HIV infection is known.
Collapse
Affiliation(s)
- G D Kelen
- Division of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Tindall B, Cooper DA, Donovan B, Penny R. Primary Human Immunodeficiency Virus Infection. Infect Dis Clin North Am 1988. [DOI: 10.1016/s0891-5520(20)30187-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
49
|
Lepage P, Van de Perre P. Nosocomial transmission of HIV in Africa: what tribute is paid to contaminated blood transfusions and medical injections? Infect Control Hosp Epidemiol 1988; 9:200-3. [PMID: 3372990 DOI: 10.1086/645833] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We reviewed the published data on the possible impact of medical injections and blood transfusions on the spread of human immunodeficiency virus (HIV) in Africa. We also compared these results to our experience in Rwanda, central Africa. The importance of medical injections in the epidemic of HIV infection seems to differ from one area to another. The excess of injections experienced by HIV seropositive subjects in Zaire could be secondary to the parenteral treatment of early HIV-related illness or to the treatment of sexually transmitted diseases, rather than being the cause of HIV infection, as suggested by Rwandese studies. In contrast, blood transfusions have been shown to represent an important source of nosocomial HIV infection in many African countries. Effective and relatively inexpensive measures to diminish the iatrogenic spread of HIV infection in developing countries are summarized.
Collapse
Affiliation(s)
- P Lepage
- Department of Pediatrics, Centre Hospitalier de Kigali, Rwanda
| | | |
Collapse
|
50
|
Krieger JN. The acquired immunodeficiency syndrome: prudent precautions for the practicing urologist. J Urol 1988; 139:801-2. [PMID: 3352049 DOI: 10.1016/s0022-5347(17)42644-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- J N Krieger
- Department of Urology, University of Washington School of Medicine, Seattle
| |
Collapse
|