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Inciarte A, Ugarte A, Martínez-Rebollar M, Torres B, Fernández E, Berrocal L, Laguno M, De la Mora L, De Lazzari E, Callau P, Chivite I, González-Cordón A, Solbes E, Rico V, Barrero L, Blanco JL, Martínez E, Ambrosioni J, Mallolas J. Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate for Nonoccupational HIV-1 Postexposure Prophylaxis: A Prospective Open-Label Trial (DORAVIPEP). Open Forum Infect Dis 2023; 10:ofad374. [PMID: 37539061 PMCID: PMC10394723 DOI: 10.1093/ofid/ofad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
Background New regimens may provide better tolerability, convenience, and safety for nonoccupational human immunodeficiency virus (HIV) postexposure prophylaxis (PEP). For this reason, we evaluated the single-tablet regimen of doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) for 28 days. Methods This was a prospective, open-label, single-arm trial including individuals with potential HIV-1 exposure within 72 hours. The primary endpoint was noncompletion of PEP at day 28. Secondary endpoints were adverse effects, adherence, and rate of seroconversion. We performed follow-up at day 7, week 4, and week 12. Results Between September 2019 and March 2022, the study enrolled 399 individuals. Median age was 30 (interquartile range [IQR], 27-36) years, and 91% (n = 364) were male. The mode of exposure was sex between men in 84% (n = 331) of cases; risk assessment for HIV-1 transmission was considered as "high" in 97% (n = 385) of the participants. Median time from exposure to consultation was 24 (IQR, 13-40) hours. Noncompletion of PEP was 29% (n = 114) (95% confidence interval [CI], 24%-33%) and 20% (n = 72) (95% CI, 16%-25%) per modified intention-to-treat. Main reasons for noncompletion were loss to follow-up (n = 104 [91%]) and intolerance (n = 8 [7%]). Older age was associated with a lower risk of premature discontinuation (OR, 0.94; P < .001). One hundred twenty-three (31%) participants reported adverse events, mostly mild and self-limited (82%); discontinuation occurred in 8 cases (2%). Adherence to PEP in the assessed users was 96%. There were no HIV seroconversions. Conclusions DOR/3TC/TDF is a well-tolerated option for nonoccupational PEP. Clinical Trials Registration. NCT04233372.
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Affiliation(s)
- Alexy Inciarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | - Ainoa Ugarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - María Martínez-Rebollar
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Berta Torres
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Emma Fernández
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Leire Berrocal
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Montserrat Laguno
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Lorena De la Mora
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
| | - Elisa De Lazzari
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Pilar Callau
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Iván Chivite
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ana González-Cordón
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Estela Solbes
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Verónica Rico
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Laura Barrero
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - José Luis Blanco
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Esteban Martínez
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Juan Ambrosioni
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Josep Mallolas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
- University of Barcelona, Faculty of Medicine, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
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Sweileh WM. Post-exposure prophylaxis against blood-borne viral infections among health care workers: A bibliometric analysis. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2022; 33:419-431. [PMID: 35213392 DOI: 10.3233/jrs-210078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health care workers face a wide range of chemical, physical, and biological occupational hazards in their jobs. OBJECTIVE The present study aimed to investigate research trends on post-exposure prophylaxis (PEP) against blood-borne viral infections among health care workers. METHOD Keywords related to health care workers, PEP, and blood-borne viruses were entered in the Scopus database for the period from 1950 to 27 January 2022. RESULTS The search query returned 271 papers. The earliest publication was in 1984. The Pan African Medical Journal ranked first (n = 8, 3.0%), followed by the Infection Control and Hospital Epidemiology and Journal of Hospital Infection with 6 (2.2%) papers for each. One hundred ninety-one journals took part in publishing the retrieved papers. Authors from 63 different countries took part in publishing the retrieved papers. The United States (US) ranked first (n = 53, 19.6%) followed by India (n = 26, 9.6%). The United States Centers for Disease Control and Prevention contributed the most (n = 9, 3.3%) and ranked first in the top active institutions. The mean number of authors per paper was 4.4 and the mean number of citations per paper was 17.0. The most frequent author keywords focused on PEP, health care workers, occupational exposure, HIV, hepatitis B, anti-retroviral and needle-stick injuries. Research themes in the retrieved papers focused on knowledge/attitude/practice and management and epidemiology of occupational exposure and PEP. There was a limited number of research publications in this field. CONCLUSION Research activity in this field needs to be strengthened in low- and middle-income countries through reporting and training of HCWs.
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Affiliation(s)
- Waleed M Sweileh
- Department of Physiology, Pharmacology/Toxicology, Division of Biomedical Sciences, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine E-mail:
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Lemoine A, Michot J, Viala J, Tounian P, Dollfus C. Antiretroviral Prophylaxis: A Digestive Complication to Know. Pediatr Emerg Care 2021; 37:e1745-e1746. [PMID: 32118832 DOI: 10.1097/pec.0000000000001952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT An 8-year-old child experienced abdominal pain and melena due to duodenal and ileal ulcerations throughout antiretroviral prophylactic treatment after a needlestick injury. Mild to moderate adverse effects often occur with lamivudine and zidovudine, but more severe adverse effects such as intestinal ulcers resulting in melena after a prophylactic antiretroviral treatment may question the safety of the current guidelines.
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Affiliation(s)
- Anaïs Lemoine
- From the Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital (APHP), Sorbonne Université, Paris, France
| | - Joëlle Michot
- Regional Center of Pharmacovigilance, Saint Antoine Hospital (APHP), Paris, France
| | - Jérôme Viala
- Department of Pediatric Gastroenterology, Robert Debré Hospital (APHP), Université Paris VII, Paris, France
| | - Patrick Tounian
- From the Pediatric Nutrition and Gastroenterology Department, Trousseau Hospital (APHP), Sorbonne Université, Paris, France
| | - Catherine Dollfus
- Pediatric Hematology and Oncology Department, Trousseau Hospital (APHP), Paris, France
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Abubakar S, Iliyasu G, Dayyab FM, Inuwa S, Tudun Wada RA, Sadiq NM, Gadanya MA, Sheshe AA, Mijinyawa MS, Habib AG. Post-exposure prophylaxis following occupational exposure to HIV and hepatitis B: an analysis of a 12-year record in a Nigerian tertiary hospital. J Infect Prev 2018; 19:184-189. [PMID: 30013623 PMCID: PMC6039908 DOI: 10.1177/1757177417746733] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 11/12/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Healthcare workers (HCWs) have an increased risk of occupational exposure to blood-borne pathogens. AIMS/OBJECTIVES We aim to examine the utilisation and outcome of post-exposure prophylaxis (PEP) for both HIV and hepatitis B (HBV) among HCWs. METHODS This was a retrospective study conducted in a tertiary hospital in North-Western Nigeria. We reviewed data on HIV or HBV PEP given to HCWs between 2004 and 2016. RESULTS A total of 115 HCWs presented for PEP during the study period. Intern doctors were the most exposed group (40/115; 34.8%). There were 86/115 (74.8%) needle stick exposures. While 53/115 (46.1%) of the sources of exposure were HIV-positive, 9/115(7.83%) were HBV-positive. Zidovudine-based regimen (40/70) was the most commonly prescribed. No seroconversion occurred among those that completed PEP treatment and follow-up. DISCUSSION No seroconversion occurred among those that received either or both HIV and HBV PEP and completed PEP treatment.
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Affiliation(s)
- Salisu Abubakar
- Department of Nursing, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Garba Iliyasu
- Infectious and Tropical Diseases Unit, Department of Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | - Farouq Muhammad Dayyab
- Infectious and Tropical Diseases Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Salisu Inuwa
- Infection Control Unit, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Nasiru Magaji Sadiq
- Department of Microbiology and Parasitology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Muktar Ahmed Gadanya
- Department of Community Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria
| | | | | | - Abdulrazaq Garba Habib
- Infectious and Tropical Diseases Unit, Department of Medicine, College of Health Sciences, Bayero University Kano, Kano, Nigeria
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Kowalska JD, Pietraszkiewicz E, Firląg-Burkacka E, Horban A. Suspected unexpected and other adverse reactions to antiretroviral drugs used as post-exposure prophylaxis of HIV infection - five-year experience from clinical practice. Arch Med Sci 2018; 14:547-553. [PMID: 29765441 PMCID: PMC5949906 DOI: 10.5114/aoms.2016.59701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/01/2016] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION With increased use of antiretroviral drugs (ARVs) in HIV uninfected persons, proper reporting on suspected unexpected serious adverse reactions (SUSARs) and continued insight into adverse drug reactions (ADRs) are needed for adequate information on safety of ARVs in such populations. MATERIAL AND METHODS Medical documentation of persons receiving ARVs after non-occupational HIV exposure (non-occupational post-exposure prophylaxis - nPEP) during 5 successive years (2009-2013) was evaluated by two HIV physicians. Adverse drug reactions s and SUSARs were defined according to international standards. In statistical analyses Cox proportional hazard models were used to identify independent predictors of developing a first ADR. RESULTS In total 375 persons received nPEP with the following indications: needle stick (43%), unprotected sexual intercourse (17%), rape (10%) and first aid (10%). In 84 (22%) cases the source patient was HIV positive or an active injecting drug user. In total 170 ADRs were reported. One hundred thirty-nine persons had only 1 ADR. The most frequent first ADRs were gastrointestinal disorders (22%), followed by general symptoms (9%), hypersensitivity reactions (1.6%) and CNS symptoms (1.3%). The remaining events represented less than 1% of all patients. Eight (2.1%) patients developed a SUSAR. In multivariate analyses only age at first visit to the clinic was an independent predictor of developing an ADR (HR = 1.17, 95% CI: 1.03-1.34; p = 0.02). CONCLUSIONS In our observations ADRs in reaction to nPEP were frequent yet usually mild events, mostly occurring in the first 2 weeks and rarely causing discontinuation. The only significant factor increasing the risk of ADR was age. SUSARs were rare, transient and clinically insignificant.
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Affiliation(s)
- Justyna D. Kowalska
- Department for Adults’ Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, Warsaw, Poland
| | | | | | - Andrzej Horban
- Department for Adults’ Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
- HIV Out-Patient Clinic, Hospital for Infectious Diseases, Warsaw, Poland
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6
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Mah ND, Birmingham AR, Treu CN, Bodkin RP, Awad NI, Acquisto NM. Sexually Transmitted Infection Review for the Acute Care Pharmacist. J Pharm Pract 2018; 33:63-73. [PMID: 29558852 DOI: 10.1177/0897190018764567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Review selected sexually transmitted infections (STIs) and treatment recommendations for pharmacists and providers practicing in the acute care setting. SUMMARY In 2015, the Centers for Disease Control and Prevention (CDC) published an updated guideline on the treatment of STIs with an emphasis on prevention and new diagnostic strategies to combat the growing problem of STIs in the United States. Despite this guidance, the incidence of infection has continued to grow. In October 2016, an in-depth analysis reported that 20 million new infections occur annually in the United States. With this growing burden of disease, it is pertinent that health-care providers optimize their treatment strategies to improve upon the management of STIs. Focusing on identification of asymptomatic- and symptomatic-infected persons, treatment, education, effective follow-up, and counseling for patients and sexual partners, emergency medicine pharmacists and providers can help minimize the negative long-term health consequences of STIs. CONCLUSION In the emergency department setting, clinical pharmacists and providers can play a crucial role in preventing and treating STIs and should continue to expand and keep current their knowledge of this topic.
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Affiliation(s)
- Nathan D Mah
- Department of Pharmacy, Oregon Health and Science University, Portland, OR, USA
| | - Asha R Birmingham
- Department of Pharmacy, Oregon Health and Science University, Portland, OR, USA
| | - Cierra N Treu
- Emergency Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Ryan P Bodkin
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Nadia I Awad
- Department of Pharmacy, Emergency Medicine Pharmacist, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Nicole M Acquisto
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA
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7
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Adherence to HIV Postexposure Prophylaxis in a Major Hospital in Northwestern Nigeria. Infect Control Hosp Epidemiol 2018; 39:247-248. [DOI: 10.1017/ice.2017.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Wyżgowski P, Rosiek A, Grzela T, Leksowski K. Occupational HIV risk for health care workers: risk factor and the risk of infection in the course of professional activities. Ther Clin Risk Manag 2016; 12:989-94. [PMID: 27366077 PMCID: PMC4913970 DOI: 10.2147/tcrm.s104942] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Virtually created panic among health care workers about pandemic acquired immune deficiency syndrome prompted us to review the scientific literature to investigate the risk of human immunodeficiency virus (HIV) transmission in the daily works of health care workers, especially surgeons and anesthesiologists. In this review, we report worldwide valuations of the number of HIV infections that may occur from unsafe daily work in health care. We also present how to minimize the risk of infection by taking precautions and how to utilize postexposure prophylaxis in accordance with the latest reports of the Centers for Disease Control and Prevention. HIV-infected patients will be aging, and most of them will become the candidates for procedures such as major vascular reconstruction and artery bypass grafting, where the risks of blood contact and staff injury are high. For these reasons, all health care workers need to know how to prevent, and fight following the accidental exposure to HIV.
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Affiliation(s)
- Przemysław Wyżgowski
- Department of General Surgery, Military Hospital, Nicolas Copernicus University in Toruń, Bydgoszcz, Poland
| | - Anna Rosiek
- Public Health Department, Faculty of Health Sciences, Nicolas Copernicus University in Toruń, Bydgoszcz, Poland
| | - Tomasz Grzela
- Department of General Surgery, Military Hospital, Nicolas Copernicus University in Toruń, Bydgoszcz, Poland
| | - Krzysztof Leksowski
- Department of General Surgery, Military Hospital, Nicolas Copernicus University in Toruń, Bydgoszcz, Poland
- Public Health Department, Faculty of Health Sciences, Nicolas Copernicus University in Toruń, Bydgoszcz, Poland
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9
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Kaplan JE, Dominguez K, Jobarteh K, Spira TJ. Postexposure Prophylaxis Against Human Immunodeficiency Virus (HIV): New Guidelines From the WHO: A Perspective. Clin Infect Dis 2016; 60 Suppl 3:S196-9. [PMID: 25972504 DOI: 10.1093/cid/civ087] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Kenneth Dominguez
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ford N, Shubber Z, Calmy A, Irvine C, Rapparini C, Ajose O, Beanland RL, Vitoria M, Doherty M, Mayer KH. Choice of antiretroviral drugs for postexposure prophylaxis for adults and adolescents: a systematic review. Clin Infect Dis 2016; 60 Suppl 3:S170-6. [PMID: 25972499 DOI: 10.1093/cid/civ092] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The choice of preferred regimens for human immunodeficiency virus postexposure prophylaxis (PEP) has evolved over the last 2 decades as more data have become available regarding the safety and tolerability of newer antiretroviral drugs. We undertook a systematic review to assess the safety and efficacy of antiretroviral options for PEP to inform the World Health Organization guideline revision process. METHODS Four databases were searched up to 1 June 2014 for studies reporting outcomes associated with specific PEP regimens. Data on PEP completion and discontinuation due to adverse events was extracted and pooled estimates were obtained using random-effects meta-analyses. RESULTS Fifteen studies (1830 PEP initiations) provided evaluable information on 2-drug regimens (zidovudine [ZDV]- or tenofovir [TDF]-based regimens), and 10 studies (1755 initiations) provided evaluable information on the third drug, which was usually a protease inhibitor. The overall quality of the evidence was rated as very low. For the 2-drug regimen, PEP completion rates were 78.4% (95% confidence interval [CI], 66.1%-90.7%) for people receiving a TDF-based regimen and 58.8% (95% CI, 47.2%-70.4%) for a ZDV-based regimen; the rate of PEP discontinuation due to an adverse event was lower among people taking TDF-based PEP (0.3%; 95% CI, 0%-1.1%) vs a ZDV-based regimen (3.2%; 95% CI, 1.5%-4.9%). For the 3-drug comparison, PEP completion rates were highest for the TDF-based regimens (TDF+emtricitabine [FTC]+lopinavir/ritonavir [LPV/r], 71.1%; 95% CI, 43.6%-98.6%; TDF+FTC+raltegravir [RAL], 74.7%; 95% CI, 41.4%-100%; TDF+FTC+ boosted darunavir [DRV/r], 93.9%; 95% CI, 90.2%-97.7%) and lowest for ZDV+ lamivudine [3TC]+LPV/r (59.1%; 95% CI, 36.2%-82.0%). Discontinuations due to adverse drug reactions were lowest for TDF+FTC+RAL (1.9%; 95% CI, 0%-3.8%) and highest for ZDV+3TC+boosted atazanavir (21.2%; 95% CI, 13.5%-30.0%). CONCLUSIONS The findings of this review provide evidence supporting the use of coformulated TDF and 3TC/FTC as preferred backbone drugs for PEP. Choice of third drug will depend on setting; for resource-limited settings, LPV/r is a reasonable choice, pending the improved availability of better-tolerated drugs with less potential for drug-drug interactions.
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Affiliation(s)
- Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Zara Shubber
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom
| | - Alexandra Calmy
- HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospital, Switzerland
| | - Cadi Irvine
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | | | | | - Rachel L Beanland
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Marco Vitoria
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Meg Doherty
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, Boston, Massachusetts
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Tetteh RA, Nartey ET, Lartey M, Mantel-Teeuwisse AK, Leufkens HGM, Nortey PA, Dodoo ANO. Adverse events and adherence to HIV post-exposure prophylaxis: a cohort study at the Korle-Bu Teaching Hospital in Accra, Ghana. BMC Public Health 2015; 15:573. [PMID: 26092496 PMCID: PMC4474444 DOI: 10.1186/s12889-015-1928-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 06/10/2015] [Indexed: 12/05/2022] Open
Abstract
Background There is strong evidence that post-exposure prophylaxis (PEP) with antiretroviral drugs in the timely management of occupational exposures sustained by healthcare workers decreases the risk of HIV infection and PEP is now widely used. Antiretroviral drugs have well documented toxicities and produce adverse events in patients living with HIV/AIDS. In the era of “highly active antiretroviral therapy”, non-adherence to treatment has been closely linked to the occurrence of adverse events in HIV patients and this ultimately influences treatment success but the influence of adverse events on adherence during PEP is less well studied. Methods Following the introduction of a HIV post-exposure prophylaxis program in the Korle-Bu Teaching Hospital in January 2005, the incidence of adverse events and adherence were documented in occupationally-exposed healthcare workers (HCWs) and healthcare students (HCSs). Cohort event monitoring was used in following-up on exposed HCWs/HCSs for the two study outcomes; adverse events and adherence. All adverse events reported were grouped by MedDRA system organ classification and then by preferred term according to prophylaxis regimen. Adherence was determined by the completion of prophylaxis schedule. Cox proportional regression analysis was applied to determine the factors associated with the cohort study outcomes. Differences in frequencies were tested using the Chi square test and p < 0.05 was considered statistically significant. Results A total of 228 exposed HCWs/HCSs were followed up during the study, made up of 101 exposed HCWs/HCSs administered lamivudine/zidovudine (3TC/AZT) for 3 days; 75 exposed HCWs/HCSs administered lamivudine/zidovudine (3TC/AZT) for 28 days; and 52 exposed HCWs/HCSs administered lamivudine/zidovudine/lopinavir-ritonavir (3TC/AZT/LPV-RTV) for 28 days. The frequency of adverse events was 28 % (n = 28) in exposed HCWs/HCSs administered 3TC/AZT for 3 days, 91 % (n = 68) in exposed HCWs/HCSs administered 3TC/AZT for 28 days and 96 % (n = 50) in exposed HCWs/HCSs administered 3TC/AZT/LPV-RTV for 28 days. Nausea was the most commonly reported adverse events in all three regimens. Adherence was complete in all exposed HCWs/HCSs administered 3TC/AZT for 3days, 56 % (n = 42) in exposed HCWs/HCSs administered 3TC/AZT for 28 days and 62 % (n = 32) in exposed HCWs/HCSs administered 3TC/AZT/LPV-RTV for 28 days. In the Cox regression multi-variate analysis, exposed HCWs/HCSs administered 3TC/AZT for 3 days were 70 % less likely to report adverse events compared with exposed HCWs/HCSs administered 3TC/AZT for 28 days (Adjusted HR = 0.30 [95 % CI, 0.18-0.48], p < 0.001). Exposed HCWs/HCSs administered 3TC/AZT for 3 days were 75 % more likely to adhere to the schedule compared with exposed HCWs/HCSs administered 3TC/AZT for 28 days (Adjusted HR = 1.75 [95 % CI, 1.16-2.66], p = 0.008). Conclusion The intolerance to adverse events was cited as the sole reason for truncating PEP, thereby indicating the need for adequate, appropriate and effective counselling, education, active follow-up (possibly through mobile /phone contact) and management of adverse events. Education on the need to complete PEP schedule (especially for exposed HCWs/HCSs on 28-day schedule) can lead to increased adherence, which is very critical in minimizing the risk of HIV sero-conversion. The present results also indicate that cohort event monitoring could be an effective pharmacovigilance tool in monitoring adverse events in exposed HCWs/HCSs on HIV post-exposure prophylaxis.
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Affiliation(s)
- Raymond A Tetteh
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. .,Pharmacy Department, Korle-Bu Teaching Hospital, P.O. Box KB 77, Korle-Bu, Accra, Ghana.
| | - Edmund T Nartey
- World Health Organisation Collaborating Centre for Advocacy and Training in Pharmacovigilance, Centre for Tropical Clinical Pharmacology & Therapeutics, School of Medicine and Dentistry, University of Ghana, P. O. Box GP 4236, Accra, Ghana.
| | - Margaret Lartey
- Department of Medicine, School of Medicine and Dentistry, University of Ghana, P. O. Box GP 4236, Accra, Ghana.
| | - Aukje K Mantel-Teeuwisse
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
| | - Hubert G M Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. .,Medicines Evaluation Board, Utrecht, The Netherlands.
| | - Priscilla A Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, P.O. Box LG 25, Legon, Accra, Ghana.
| | - Alexander N O Dodoo
- World Health Organisation Collaborating Centre for Advocacy and Training in Pharmacovigilance, Centre for Tropical Clinical Pharmacology & Therapeutics, School of Medicine and Dentistry, University of Ghana, P. O. Box GP 4236, Accra, Ghana.
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Assessment of Prevalence and Determinants of Occupational Exposure to HIV Infection among Healthcare Workers in Selected Health Institutions in Debre Berhan Town, North Shoa Zone, Amhara Region, Ethiopia, 2014. AIDS Res Treat 2014; 2014:731848. [PMID: 25478213 PMCID: PMC4247935 DOI: 10.1155/2014/731848] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/26/2014] [Accepted: 10/14/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Health care workers are exposed to different kinds of occupational hazards due to their day to day activities. The most common occupational exposure like body fluids is a potential risk of transmission of blood-borne infection like human immunodeficiency virus. Objective. To assess the prevalence and determinants of occupational exposure to human immunodeficiency virus infection. Methods and Materials. A descriptive cross-sectional institution based study was conducted in selected four health institutions in Debre Berhan town. Quantitative and qualitative data were collected using semistructured interviewer administered questionnaire. The frequency distribution of dependent and independent variables was worked out and presented using frequency table, graph, and chart. Result. The overall prevalence of occupational exposure of the health care workers was found to be 88.6% (n = 187) in the past 12 months. Contact to potentially infectious body fluids accounts for the largest proportion (56.7%) followed by needle stick injury (31.5%) and glove breakage (28.8%). Conclusion. In this study majority (88.6%) of the health care workers had a risky occupational hazard that exposed them to human immunodeficiency virus infection during the past 12 months. The statistically significant determinant factors were professional status, working room, and time of personal protective equipment usage.
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Montufar Andrade FE, Madrid Muñoz CA, Villa Franco JP, Diaz Correa LM, Vega Miranda J, Vélez Rivera JD, Palacio Castaño VM, Zuleta Tobón JJ, Montufar Pantoja MC, Salazar Valderrama N, Pérez Jaramillo LE, Monsalve MA, Zapata H, Mejia M. Accidentes ocupacionales de riesgo biológico en Antioquia, Colombia. Enero de 2010 a diciembre de 2011. INFECTIO 2014. [DOI: 10.1016/j.infect.2014.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Kuhar DT, Henderson DK, Struble KA, Heneine W, Thomas V, Cheever LW, Gomaa A, Panlilio AL. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol 2014; 34:875-92. [PMID: 23917901 DOI: 10.1086/672271] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This report updates US Public Health Service recommendations for the management of healthcare personnel (HCP) who experience occupational exposure to blood and/or other body fluids that might contain human immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis (PEP) regimens and the duration of HIV follow-up testing for exposed personnel have been updated. This report emphasizes the importance of primary prevention strategies, the prompt reporting and management of occupational exposures, adherence to recommended HIV PEP regimens when indicated for an exposure, expert consultation in management of exposures, follow-up of exposed HCP to improve adherence to PEP, and careful monitoring for adverse events related to treatment, as well as for virologic, immunologic, and serologic signs of infection. To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns, and institutions should take steps to ensure that staff are aware of both the importance of and the institutional mechanisms available for reporting and seeking care for such exposures. The following is a summary of recommendations: (1) PEP is recommended when occupational exposures to HIV occur; (2) the HIV status of the exposure source patient should be determined, if possible, to guide need for HIV PEP; (3) PEP medication regimens should be started as soon as possible after occupational exposure to HIV, and they should be continued for a 4-week duration; (4) new recommendation-PEP medication regimens should contain 3 (or more) antiretroviral drugs (listed in Appendix A ) for all occupational exposures to HIV; (5) expert consultation is recommended for any occupational exposures to HIV and at a minimum for situations described in Box 1 ; (6) close follow-up for exposed personnel ( Box 2 ) should be provided that includes counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity; follow-up appointments should begin within 72 hours of an HIV exposure; and (7) new recommendation-if a newer fourth-generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded 4 months after exposure ( Box 2 ); if a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after an HIV exposure.
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Affiliation(s)
- David T Kuhar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Kijak GH, Kim JH. Timing, adherence, resistance, and ... persistence? new insight into the mechanisms of failure of HIV type 1 postexposure prophylaxis. J Infect Dis 2013; 208:1542-4. [PMID: 24023256 DOI: 10.1093/infdis/jit486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gustavo H Kijak
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
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Abstract
Postexposure prophylaxis (PEP) has substantially reduced the risk of acquiring human immunodeficiency virus (HIV) after an occupational exposure; nevertheless, exposure to HIV remains a concern for emergency department providers. According to published guidelines, PEP should be taken only when source patients are HIV-positive or have risk factors for HIV. Initiating PEP when source patients are uninfected puts exposed persons at risk from taking toxic drugs with no compensating benefit. Forgoing PEP if the source is infected results in increased risk of acquiring HIV. What should be done if source patients refuse HIV testing? Is it justifiable to test the blood of these patients over their autonomous objection? The authors review current law and policy and perform an ethical analysis to determine if laws permitting unconsented testing in cases of occupational exposure can be ethically justified.
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Affiliation(s)
- Ethan Cowan
- Department of Emergency Medicine, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA.
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Mbaeyi C, Panlilio AL, Hobbs C, Patel PR, Kuhar DT. Assessment of Management Policies and Practices for Occupational Exposure to Bloodborne Pathogens in Dialysis Facilities. Am J Kidney Dis 2012; 60:617-25. [DOI: 10.1053/j.ajkd.2012.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 05/23/2012] [Indexed: 11/11/2022]
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Schmid I. How to develop a standard operating procedure for sorting unfixed cells. Methods 2012; 57:392-7. [PMID: 22381383 PMCID: PMC3380136 DOI: 10.1016/j.ymeth.2012.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 01/27/2012] [Accepted: 02/08/2012] [Indexed: 11/30/2022] Open
Abstract
Written standard operating procedures (SOPs) are an important tool to assure that recurring tasks in a laboratory are performed in a consistent manner. When the procedure covered in the SOP involves a high-risk activity such as sorting unfixed cells using a jet-in-air sorter, safety elements are critical components of the document. The details on sort sample handling, sorter set-up, validation, operation, troubleshooting, and maintenance, personal protective equipment (PPE), and operator training, outlined in the SOP are to be based on careful risk assessment of the procedure. This review provides background information on the hazards associated with sorting of unfixed cells and the process used to arrive at the appropriate combination of facility design, instrument placement, safety equipment, and practices to be followed.
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Affiliation(s)
- Ingrid Schmid
- David Geffen School of Medicine at UCLA, Department of Hematology/Oncology, Los Angeles, USA.
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Diaz–Brito V, León A, Knobel H, Peraire J, Domingo P, Clotet B, Dalmau D, Cruceta A, Arnaiz JA, Gatell JM, García F. Post-exposure prophylaxis for HIV infection: a clinical trial comparing lopinavir/ritonavir versus atazanavir each with zidovudine/lamivudine. Antivir Ther 2011; 17:337-46. [DOI: 10.3851/imp1955] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2011] [Indexed: 10/15/2022]
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Roan R, Holt S. Needlestick over the Pacific Ocean! Now What? Air Med J 2010; 29:292-3, 308. [PMID: 21055642 DOI: 10.1016/j.amj.2010.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 05/13/2010] [Accepted: 05/15/2010] [Indexed: 11/25/2022]
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Postexposure prophylaxis, preexposure prophylaxis or universal test and treat: the strategic use of antiretroviral drugs to prevent HIV acquisition and transmission. AIDS 2010; 24 Suppl 4:S27-39. [PMID: 21042050 DOI: 10.1097/01.aids.0000390705.73759.2c] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review considers the use of antiretroviral drugs specifically to prevent HIV transmission. Antiretroviral therapy (ART) can be implemented for the protection of uninfected individuals both before (preexposure prophylaxis) and after (postexposure prophylaxis) exposure to HIV infection. Preexposure prophylaxis may be used coitally dependently when individuals are intermittently exposed or by continuous daily dosing for those constantly exposed; postexposure prophylaxis is used in 28-day courses. Alternatively, ART can be used strategically to reduce the viral load and consequent infectiousness of an HIV-infected individual, thereby limiting the risk of onward viral transmission. A policy of universal HIV testing to enhance the identification of all HIV-positive individuals followed by immediate treatment of all HIV-positive individuals, irrespective of their CD4 cell counts (universal test and treat), has been postulated as a potential tool capable of reducing HIV incidence at a population level. This concept represents a paradigm shift in the use of ART, targeting infectious individuals for prevention rather than protecting uninfected exposed populations. This strategy could have the advantage of preventing transmission and reducing HIV incidence at a population level, as well as delivering universal access to therapy for all people living with HIV and AIDS, potentially eliminating mother-to-child HIV transmission and limiting concomitant diseases such as tuberculosis. This review critically examines the scientific basis of ART for HIV prevention, summarizing the risks and opportunities of the potential expansion of ART for prevention. Specifically, we consider the evidences for and against targeting HIV-uninfected individuals compared with enhanced HIV testing and treatment of HIV-infected individuals in terms of impact on viral transmission.
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Wong K, Hughes CA, Plitt S, Foisy M, MacDonald J, Johnson M, Singh AE. HIV non-occupational postexposure prophylaxis in a Canadian province: treatment completion and follow-up testing. Int J STD AIDS 2010; 21:617-21. [DOI: 10.1258/ijsa.2008.008482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Provincial guidelines for HIV non-occupational postexposure prophylaxis (NPEP) were implemented on January 2005 in Alberta, Canada. Human immunodeficiency virus (HIV) NPEP was provided free of charge following approval by a medical officer of health. Between 1 January 2005 and 30 June 2007, 174 individuals were prescribed NPEP; 135 (78%) were women with a median age of 24 years. Sexual assaults accounted for 68% of exposures. NPEP was completed in 49% of cases. Individuals who completed NPEP were less likely to have been exposed by sexual assault ( P = 0.04) and more likely to have received HIV follow-up testing ( P = 0.03).Individuals who received at least one HIV follow-up test were older ( P = 0.03) and more likely to have been exposed percutaneously ( P = 0.003). Those who received no follow-up testing were less likely to have filled an NPEP prescription ( P = 0.0001). New strategies are required to improve follow-up of individuals receiving NPEP, especially younger persons or sexual assault survivors.
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Affiliation(s)
- K Wong
- Alberta Health Services, Capital Health
| | - C A Hughes
- Alberta Health Services, Capital Health
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta
- Northern Alberta HIV Program, Edmonton, Alberta
| | - S Plitt
- Public Health Agency of Canada, Ottawa, Ontario
| | - M Foisy
- Alberta Health Services, Capital Health
- Northern Alberta HIV Program, Edmonton, Alberta
| | - J MacDonald
- Alberta Health Services, Calgary Health Region, Calgary
| | - M Johnson
- Alberta Health Services, Capital Health
| | - A E Singh
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Gay CL, Cohen MS. Antiretrovirals to prevent HIV infection: pre- and postexposure prophylaxis. Curr Infect Dis Rep 2010; 10:323-31. [PMID: 18765106 DOI: 10.1007/s11908-008-0052-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
More than 3 million people are now receiving antiretroviral therapy (ART) worldwide. Currently, the indications for ART depend primarily on CD4 count, blood viral burden, and clinical signs and symptoms suggesting advanced HIV disease. However, interest is increasing in ART's preventive potential. Postexposure prophylaxis following both occupational and nonoccupational exposure to HIV is the standard-of-care in many settings. Observational and ecologic studies suggest that ART administered to HIV-infected people reduces transmission within serodiscordant couples. Pre-exposure prophylaxis to prevent HIV infection is a potentially safe and intermittent intervention for very high-risk people, and clinical trials to evaluate this preventive strategy are underway. The prevention benefits of ART may begin to affect the decision of when to start therapy and add a much-needed strategy to current HIV prevention efforts.
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Affiliation(s)
- Cynthia L Gay
- Division of Infectious Disease, University of North Carolina at Chapel Hill, 130 Mason Farm Road, CB #7030, Chapel Hill, NC 27599, USA.
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Manfredi R. Occupational Exposure and Prevention Guidelines in Dental and Stomatological Settings - A Literature Review. INFECTIO 2010. [DOI: 10.1016/s0123-9392(10)70094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Wald J. The psychological consequences of occupational blood and body fluid exposure injuries. Disabil Rehabil 2010; 31:1963-9. [PMID: 19479544 DOI: 10.1080/09638280902874147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This article describes the psychological impact of occupational blood and body fluid (BBF) exposure injuries and provides suggestions for improving clinical practice. METHOD A literature review was conducted to search for articles relating to the psychological consequences and management of these work injuries. RESULTS Acute psychological symptoms including posttraumatic stress, anxiety and depression are frequently experienced postexposure, which appear to be the major contributing factors of time loss from work. Furthermore, a subgroup is at risk for chronic symptoms and disability that persists beyond notification that no disease transmission occurred. Distressed workers often go unrecognised and untreated, and their assistance needs are largely unknown. Accordingly, this article draws upon the posttraumatic stress literature to offer suggestions for advancing the postexposure management of these injuries. CONCLUSIONS This clinical commentary underscores the serious yet understudied secondary psychological effects of occupational BBF exposure injuries. Postexposure management programmes need to place greater emphasis on psychosocial and educational initiatives to improve the identification and treatment of symptomatic workers.
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Affiliation(s)
- Jaye Wald
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, British Columbia, Canada.
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Tolerability and efficacy of PI versus NNRTI-based regimens in subjects receiving HAART during acute or early HIV infection. J Acquir Immune Defic Syndr 2009; 50:267-75. [PMID: 19194317 DOI: 10.1097/qai.0b013e3181963ae6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about modifications to highly active antiretroviral therapy (HAART) initiated during acute or early HIV infection. METHODS Reasons for first modifications of HAART regimens were recorded using the AIDS Clinical Trials Group form among 363 subjects who initiated HAART within 1 year of seroconversion from 2005 in the Acute Infection and Early Disease Research Program. Modifications recorded as due to "patient choice" or "physician choice" were clarified by query to the recording site. Times to events were analyzed by Kaplan-Meier methods; significance of differences was assessed by the log-rank test. RESULTS Two hundred five of 363 (56%) subjects modified therapy, at a median of 425 days after initiation, by changing drugs, discontinuing treatment, or removing or adding drugs. Most modifications were attributed to toxicity (n = 105, 51%), most of which was low grade; regimen simplification (n = 18, 5%); and achievement of viral suppression (n = 15, 7%). Time to first modification was shorter for those with shorter time from infection to initiation (P = 0.005) and those having higher CD4 lymphocyte count at initiation (P = 0.06). Modifications occurred sooner in subjects receiving regimens taken more than once daily (P < 0.001) or with more than 2 pills daily (P < 0.001). Most regimens were nonnucleoside reverse transcriptase inhibitor based or protease inhibitor based, and these did not differ significantly in rate and timing of modification. CONCLUSIONS HAART initiated early in HIV infection was modified in the majority of cases, usually due to minor toxicities whose incidence was similar for protease inhibitor-based and nonnucleoside reverse transcriptase inhibitor-based regimens. Convenience of regimens (lower pill burden and dosing frequency) was associated with a lower rate of modification.
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Single-molecule immunosorbent assay as a tool for human immunodeficiency virus-1 antigen detection. Anal Bioanal Chem 2009; 394:489-97. [PMID: 19267241 DOI: 10.1007/s00216-009-2712-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/13/2009] [Accepted: 02/16/2009] [Indexed: 10/21/2022]
Abstract
Ultrasensitive detection and quantification of viral antigen with a novel single-molecule immunosorbent assay (SMISA) was achieved. Antigen from human immunodeficiency virus type 1 (HIV-1), the major etiological agent of acquired immune deficiency syndrome, served as the screening target in this study. The target molecule was sandwiched between a polyclonal capture antibody and a monoclonal detector antibody. The capture antibody was covalently immobilized on (3-glycidoxypropyl) trimethoxy silane-modified glass slides. The detector antibody was conjugated with fluorescent Alexa Fluor 532 labeled secondary antibody prior to being used as a probe for the antigen. Imaging was performed with a total internal reflection fluorescence single-molecule detection system. This technique is demonstrated for detecting HIV-1 p24 antigen down to 0.1 pg/mL with a dynamic range of over four orders of magnitude. A Langmuir isotherm fits the molecule count dependence on the target concentration. The target antigen was further tested in 20% human serum, and the results showed that neither sensitivity nor dynamic range was affected by the biological matrix. SMISA is therefore a promising approach for the early diagnosis of viral induced diseases.
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HIV postexposure prophylaxis after sexual assault: why is it so hard to accomplish? Sex Transm Dis 2009; 35:979-80. [PMID: 18955917 DOI: 10.1097/olq.0b013e31818f2af4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schmid I, Lambert C, Ambrozak D, Perfetto SP. Standard safety practices for sorting of unfixed cells. ACTA ACUST UNITED AC 2008; Chapter 3:Unit3.6. [PMID: 18770851 DOI: 10.1002/0471142956.cy0306s39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cell sorting of viable biological specimens has become widespread in laboratories involved in basic and clinical research. As these samples can contain infectious agents, precautions to protect instrument operators and the environment from hazards arising from the use of sorters are paramount. This unit presents a revised and updated version of the biosafety guidelines for sorting of unfixed cells established in 1977 by the International Society of Analytical Cytology (ISAC), whose recommendations have become recognized worldwide as the standard practices and safety precautions for laboratories performing viable cell-sorting experiments. The unit contains background information on the biohazard potential of sorting and the hazard classification of infectious agents as well as recommendations on (1) sample handling, (2) operator training and personal protection, (3) laboratory design, (4) cell sorter setup, maintenance, and decontamination, and (5) testing the instrument for the efficiency of aerosol containment.
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Affiliation(s)
- Ingrid Schmid
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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30
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Ehui E, Kra O, Ouattara I, Eholié S, Kakou A, Bissagnéné E, Kadio A. Prise en charge des accidents d'exposition au sang au CHU de Treichville, Abidjan (Côte-d'Ivoire). Med Mal Infect 2007; 37 Suppl 3:S251-6. [PMID: 17512149 DOI: 10.1016/j.medmal.2007.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 03/07/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to assess care and preventive measures for accidental exposure to blood (AEB) in Abidjan. METHODS A retrospective study of all AEB reported in the Infectious and Tropical Diseases Center of the Treichville University Hospital was made between January 2000 and December 2005. Epidemiology, management, clinical and biological post-exposure follow-up were analyzed. RESULTS One hundred eighty-two AEB were managed over 6 years (151 needlesticks, 14 ocular projections of blood, 12 cuts, and 5 mucocutaneous exposure to blood). 94 men (51.6%) and 68 women (48.4%) were included [sex ratio 1.4] mean age 33.8 years+/-7.4 years. Physicians (29.1%), nurses (19.8%), assistant nurse (12.1%), and medical students (11.4%) were the professional categories which declared most accidents. Among them, only 51.1% was correctly vaccinated against hepatitis B. The average delay of consultation was 26.5 hours (1-240 hours), and 82.9% of victims consulted before the 48th hour. Antiretroviral prophylaxis was prescribed to 151 patients among whom 45% with bitherapy (Zidovudine and Lamivudine), and 55% with HAART including an antiprotease. Only 60 patients had one actual month of treatment. Despite the weak follow-up, no case of HIV seroconversion was reported 6 month after exposure. CONCLUSION This work underlines once again the high frequency of AEB in Abidjan despite a under reporting, and calls for the implementation of a policy to train health care workers on AEB preventive measures.
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Affiliation(s)
- E Ehui
- Service des maladies infectieuses et tropicales, CHU de Treichville, 01 BP V 3 Abidjan 01, Côte-d'Ivoire.
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Spence JM. Should emergency departments offer postexposure prophylaxis for non-occupational exposure to HIV? CAN J EMERG MED 2007; 5:38-45. [PMID: 17659152 DOI: 10.1017/s1481803500008101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Julie M Spence
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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Grohskopf LA, Paxton LA. Postexposure Prophylaxis for HIV in Children and Adolescents After Sexual Assault: A Prospective Observational Study in an Urban Medical Center. Sex Transm Dis 2007; 34:69-70. [PMID: 17251751 DOI: 10.1097/01.olq.0000253345.57228.fe] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lisa A Grohskopf
- Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Young TN, Arens FJ, Kennedy GE, Laurie JW, Rutherford GW. Antiretroviral post-exposure prophylaxis (PEP) for occupational HIV exposure. Cochrane Database Syst Rev 2007; 2007:CD002835. [PMID: 17253483 PMCID: PMC8989146 DOI: 10.1002/14651858.cd002835.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Populations such as healthcare workers (HCWs), injection drug users (IDUs), and people engaging in unprotected sex are all at risk of being infected with the human immunodeficiency virus (HIV). Animal models show that after initial exposure, HIV replicates within dendritic cells of the skin and mucosa before spreading through lymphatic vessels and developing into a systemic infection (CDC 2001). This delay in systemic spread leaves a "window of opportunity" for post-exposure prophylaxis (PEP) using antiretroviral drugs designed to block replication of HIV (CDC 2001). PEP aims to inhibit the replication of the initial inoculum of virus and thereby prevent establishment of chronic HIV infection. OBJECTIVES To evaluate the effects of antiretroviral PEP post-occupational exposure to HIV. SEARCH STRATEGY The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AIDSearch, and the Database of Abstracts of Reviews of Effectiveness were searched from 1985 to January 2005 to identify controlled trials. There were no language restrictions. Because no controlled clinical trials were retrieved, the search was repeated on 31 May 2005 in MEDLINE, AIDSearch and EMBASE using a search strategy to identify analytic observational studies. Handsearches of the reference lists of all pertinent reviews and studies found were also undertaken. Experts in the field of HIV prevention were contacted. SELECTION CRITERIA Types of studies: All controlled trials (including randomized clinical trials and controlled clinical trials). If no controlled trials were found, analytic studies (e.g. cohort and case-control studies) were considered. Descriptive studies (i.e. studies with no comparison groups) were excluded. Types of participants included:HCWs exposed to any known or potentially HIV contaminated product;anyone exposed to a needlestick contaminated by known or potentially HIV-infected blood or other bodily fluid in an occupational setting; andanyone exposed through the mucous membranes to an HIV-infected or potentially infected substance in occupational setting.Excluded: Sex workers (PEP post-sexual exposure is addressed in another Cochrane review (Martín 2005)). Types of interventions: Any intervention that administered single or combinations of antiretrovirals as PEP to people exposed to HIV through percutaneous injuries and/or occupational mucous membrane exposures when the HIV status of the source patient was positive or unknown. Studies comparing two types of PEP regimens were considered, as were studies comparing PEP with no intervention. Types of outcome measures:Incidence of HIV infection in those given PEP versus those given placebo or a different PEP regimen; Adherence to PEP; Complications of PEPTypes of outcome measures: Incidence of HIV infection in those given PEP versus those given placebo or a different PEP regimen; Adherence to PEP; Complications of PEP DATA COLLECTION AND ANALYSIS: Data concerning outcomes, details of the interventions, and other study characteristics were extracted by two independent authors (TY and JA) using a standardized data extraction form (Table 04). A third author (GK) resolved disagreements. The following information was gathered from each included study: location of study, date, publication status, demographics (e.g. age, gender, occupation, risk behavior, etc.) of participants/exposure modality, form of PEP used, duration of use, and outcomes. Odds ratios with a 95% confidence interval (CI) were used as the measure of effect. A meta-analysis was performed for adverse events where two-drug regimens were compared with three-drug regimens. Due to overlap between Puro 2000 and Puro 2005, the former was not included in the combined analysis. MAIN RESULTS Effect of PEP on HIV seroconversionNo randomized controlled trials were identified. Only one case-control study was included. HIV transmission was significantly associated with deep injury (OR 15, 95% CI 6.0 to 41), visible blood on the device (OR 6.2, 95% CI 2.2 to 21), procedures involving a needle placed in the source patient's blood vessel (OR 4.3, 95% CI 1.7 to 12), and terminal illness in the source patient (OR 5.6, 95% CI 2.0 to 16). After controlling for these risk factors, no differences were detected in the rates at which cases and controls were offered post-exposure prophylaxis with zidovudine. However, cases had significantly lower odds of having taken zidovudine after exposure compared to controls (OR 0.19, 95%CI 0.06 to 0.52). No studies were found that evaluated the effect of two or more antiretroviral drugs for occupational PEP. Adherence to and complications with PEPEight reports from observational comparative studies confirmed findings that adverse events were higher with a three-drug regimen, especially one containing indinavir. However, discontinuation rates were not significantly different. AUTHORS' CONCLUSIONS The use of occupational PEP is based on limited direct evidence of effect. However, it is highly unlikely that a definitive placebo-controlled trial will ever be conducted, and, therefore, on the basis of results from a single case-control study, a four-week regimen of PEP should be initiated as soon as possible after exposure, depending on the risk of seroconversion. There is no direct evidence to support the use of multi-drug antiretroviral regimens following occupational exposure to HIV. However, due to the success of combination therapies in treating HIV-infected individuals, a combination of antiretroviral drugs should be used for PEP. Healthcare workers should be counseled about expected adverse events and the strategies for managing these. They should also be advised that PEP is not 100% effective in preventing HIV seroconversion. A randomized controlled clinical trial is neither ethical nor practical. Due to the low risk of HIV seroconversion, a very large sample size would be required to have enough power to show an effect. More rigorous evaluation of adverse events, especially in the developing world, are required. Seeing that current practice is partly based on results from individual primary animal studies, we recommend a formal systematic review of all relevant animal studies.
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Affiliation(s)
- T N Young
- Medical Research Council, South African Cochrane Centre, PO Box 19070, Tygerberg, South Africa, 7505.
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Azar-Cavanagh M, Burdt P, Green-McKenzie J. Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers. Infect Control Hosp Epidemiol 2007; 28:165-70. [PMID: 17265397 DOI: 10.1086/511699] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 07/11/2005] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the effect of introducing an engineered device for preventing injuries from sharp instruments (engineered sharps injury prevention device [ESIPD]) on the percutaneous injury rate in healthcare workers (HCWs). METHODS We undertook a controlled, interventional, before-after study during a period of 3 years (from January 1998 through December 2000) at a major medical center. The study population was HCWs with potential exposure to bloodborne pathogens. HCWs who sustain a needlestick injury are required by hospital policy to report the exposure. A confidential log of these injuries is maintained that includes information on the date and time of the incident, the type and brand of sharp device involved, and whether an ESIPD was used. INTERVENTION Introduction of an intravenous (IV) catheter stylet with a safety-engineered feature (a retractable protection shield), which was placed in clinics and hospital wards in lieu of other IV catheter devices that did not have safety features. No protective devices were present on suture needles during any of the periods. The incidence of percutaneous needlestick injury by IV catheter and suture needles was evaluated for 18 months before and 18 months after the intervention. RESULTS After the intervention, the incidence of percutaneous injuries resulting from IV catheters decreased significantly (P<.01), whereas the incidence of injuries resulting from suture needle injuries increased significantly (P<.008). CONCLUSION ESIPDs lead to a reduction in percutaneous injuries in HCWs, helping to decrease HCWs' risk of exposure to bloodborne pathogens.
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Landrum ML, Wilson CH, Perri LP, Hannibal SL, O'Connell RJ. Usefulness of a rapid human immunodeficiency virus-1 antibody test for the management of occupational exposure to blood and body fluid. Infect Control Hosp Epidemiol 2006; 26:768-74. [PMID: 16209383 DOI: 10.1086/502615] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the usefulness of the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, PA) in cases of occupational exposure regarding its use with source-patient sera, effects on post-exposure prophylaxis (PEP) use, potential cost savings, and effects on healthcare worker (HCW) stress reaction symptoms. DESIGN Before-and-after analysis. SETTING A 269-bed, tertiary-care medical center with adjacent clinics. PARTICIPANTS All source-patients and HCWs experiencing an occupational exposure during the study period. METHODS Use of the OraQuick test with patient sera was validated prior to its use for occupational exposures. Exposures from January 1 through July 10, 2003 (enzyme immunoassay [EIA] group) and July 11 through December 31, 2003 (OraQuick group) were retrospectively reviewed and the use and cost of PEP was compared for each group. Randomly selected HCWs from both groups completed a survey to assess their stress reaction symptoms. RESULTS After exclusion, there were 71 exposures in the EIA group and 79 in the OraQuick group. OraQuick results were 100% concordant with the reference standard of EIA and Western blot using patient sera. The mean number of doses ingested per course of PEP was significantly higher for HCWs in the EIA group (3.8; range, 0 to 6) compared with the OraQuick group (1.2; range, 0 to 3; P = .016). Cost analysis revealed a mean savings of dollar 6.62 with the OraQuick test per occupational exposure. Although the survey failed to detect an overall reduction in HCW stress reaction symptoms using OraQuick for source-patient testing, 11 HCWs in the EIA group had repetitive thoughts of the exposure compared with 5 in the OraQuick group (P = .049). CONCLUSION Because of the reduction in ingested doses of unnecessary PEP and reduced cost of occupational exposure management with their use, rapid HIV-antibody tests should be the preferred method for source-patient testing following an occupational exposure.
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Affiliation(s)
- Michael L Landrum
- Department of Infectious Diseases, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas 78236, USA.
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Rabaud C, Burty C, Grandidier M, Christian B, Penalba C, Béguinot I, Jeanmaire H, May T. Tolerability of Postexposure Prophylaxis with the Combination of Zidovudine-Lamivudine and Lopinavir-Ritonavir for HIV Infection. Clin Infect Dis 2005; 40:303-5. [PMID: 15655751 DOI: 10.1086/426589] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 09/01/2004] [Indexed: 11/03/2022] Open
Abstract
Tolerability of the combination of zidovudine-lamivudine and lopinavir-ritonavir as postexposure prophylaxis (PEP) for human immunodeficiency virus infection was prospectively assessed. A total of 121 patients were enrolled in the study; 23 patients discontinued PEP prematurely for reasons other than adverse events. Of the other 98 patients, 58 (59%) experienced adverse effects, which led to premature PEP discontinuation in 20 cases (20%).
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Affiliation(s)
- Christian Rabaud
- Centre d'Information et de Soins sur l'Immunodeficience Humaine, Lorraine Champagne-Ardenne, France.
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Katz MH, Gerberding JL. Management of occupational and nonoccupational postexposure HIV prophylaxis. Curr HIV/AIDS Rep 2004; 1:159-65. [PMID: 16091237 DOI: 10.1007/s11904-004-0025-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The principles of managing patients with recent HIV exposures are similar whether the exposure occurs in an occupational or nonoccupational setting. For both settings, clinicians should 1) assess the likelihood that HIV and other bloodborne viruses will be transmitted as a consequence of the exposure; 2) advise the patient about the risks and benefits of treatment; 3) choose an appropriate antiretroviral treatment regimen (if the decision is made to treat); 4) screen for other illnesses that may complicate treatment or follow-up; 5) counsel patients about the importance of adhering to treatment; 6) promote safe-sex practices and methods to avoid future exposures; 7) follow the patient for potential side effects of treatment; 8) provide follow-up care including repeat HIV testing for seroconversion, surveillance for primary HIV infection, and reinforcement of counseling messages.
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Affiliation(s)
- Mitchell H Katz
- San Francisco Department of Public Health, 101 Grove Street, San Francisco, CA 94102, USA.
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Puro V, Cicalini S, De Carli G, Soldani F, Antunes F, Balslev U, Begovac J, Bernasconi E, Boaventura JL, Martí MC, Civljak R, Evans B, Francioli P, Genasi F, Larsen C, Lot F, Lunding S, Marcus U, Pereira AA, Thomas T, Schonwald S, Ippolito G. Post-exposure prophylaxis of HIV infection in healthcare workers: recommendations for the European setting. Eur J Epidemiol 2004; 19:577-84. [PMID: 15330131 DOI: 10.1023/b:ejep.0000032349.57057.8a] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The European Commission funded a project for the standardisation of the management of occupational exposures to HIV/blood-borne infections and antiretroviral post-exposure prophylaxis (PEP) in Europe. Within this project, the following recommendations and rationale were formulated by experts representative of participating countries. Based on assessment of the exposure, material, and source characteristics, PEP should be started as soon as possible with any triple combination of antiretrovirals approved for the treatment of HIV-infected patients; initiation is discouraged after 72 hours Rapid HIV testing of the source could reduce inappropriate PEP. HIV testing should be performed at baseline, 4, 12, and 24 weeks, with additional clinical and laboratory monitoring of adverse reactions and potential toxicity at week 1 and 2. HIV resistance tests in the source and direct virus assays in the exposed HCW are not recommended routinely. These easy-to-use recommendations seek to maximise PEP effect while minimising its toxicity and inappropriate use.
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Affiliation(s)
- Vincenzo Puro
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy.
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Trapé-Cardoso M, Schenck P. Reducing percutaneous injuries at an academic health center: a 5-year review. Am J Infect Control 2004; 32:301-5. [PMID: 15292897 DOI: 10.1016/j.ajic.2003.12.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The University of Connecticut Health Center Employee Health Service collected and used National Surveillance System for Hospital Health Care Workers (NaSH) data to (1) improve surveillance of health care worker blood and body fluid exposures (BBFEs) and (2) target specific interventions for higher-risk groups (nursing staff, medical and dental students, and residents). METHODS All 870 BBFE incidents were abstracted from the NaSH database from the 1997 through 2002 academic years. Incidence rates per 100 full-time-equivalent workers were determined for each targeted occupation group with 95% confidence intervals. RESULTS The number of percutaneous injuries declined among medical/dental students and nursing staff, and to a lesser degree for residents. The incidence rates decreased from 7.9% in 2000 to 2001 to 2.6% in 2001 to 2002 for students and from 9.2% in 1997 to 1998 to 2.7% in 2001 to 2002 for nursing staff. CONCLUSIONS Data from a surveillance database provided guidance for administrative, educational, and engineering control interventions. Active surveillance and periodic review of interventions are important aspects to reduce BBFEs in targeted high-risk occupational groups, especially when the workforce has a high turnover, as is typical in academic health centers.
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Affiliation(s)
- Marcia Trapé-Cardoso
- Division of Occupational and Environmental Medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington, USA
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Bassett IV, Freedberg KA, Walensky RP. Two drugs or three? Balancing efficacy, toxicity, and resistance in postexposure prophylaxis for occupational exposure to HIV. Clin Infect Dis 2004; 39:395-401. [PMID: 15307008 DOI: 10.1086/422459] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 03/31/2004] [Indexed: 11/04/2022] Open
Abstract
Thousands of health care workers are potentially exposed to human immunodeficiency virus (HIV) each year via occupationally acquired needlesticks. The Centers for Disease Control and Prevention (Atlanta, GA) advise health care workers who experience a high-risk occupational exposure from an HIV-infected patient to begin receiving multidrug antiretroviral postexposure prophylaxis (PEP) as soon as possible, preferably within 36 h after exposure. Although the need to prescribe antiretroviral postexposure prophylaxis in a timely fashion is common, few data exist regarding the efficacy and optimal regimen for prophylaxis to prevent transmission. Our objectives were to examine the limited human and animal data on postexposure prophylaxis, to elucidate the factors that affect the choice of 2 versus 3 drugs as the optimal prophylactic drug regimen, and to place these findings within a mathematical framework to help guide the prescription of PEP.
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Affiliation(s)
- Ingrid V Bassett
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Puro V, Francisci D, Sighinolfi L, Civljak R, Belfiori B, Deparis P, Roda R, Modestino R, Ghinelli F, Ippolito G. Benefits of a rapid HIV test for evaluation of the source patient after occupational exposure of healthcare workers. J Hosp Infect 2004; 57:179-82. [PMID: 15183251 DOI: 10.1016/j.jhin.2004.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2003] [Accepted: 03/01/2004] [Indexed: 10/26/2022]
Abstract
Rapid human immunodeficiency virus (HIV) testing for the management of occupational exposure of healthcare workers significantly decreased the number of anti-retroviral post-exposure prophylaxis regimens started whilst awaiting HIV test results. The study confirmed an equivalent performance of the rapid test in comparison with HIV enzyme immunoassay, and suggests it is cost-effective. In addition, two other potential benefits emerged: reducing the number of source patients who remain untested and increasing the number of occupational exposures reported.
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Affiliation(s)
- V Puro
- Dipartimento di Epidemiologia, Istituto Nazionale per le Malattie Infettive, Lazzaro Spallanzani, IRCCS, Via Portuense 292, 00149 Rome, Italy.
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Hudson A, Kirksey K, Holzemer W. The influence of symptoms on quality of life among HIV-infected women. West J Nurs Res 2004; 26:9-23; discussion 24-30. [PMID: 14984639 DOI: 10.1177/0193945903259221] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Symptoms serve as intervention foci for patients and health care providers. Research has established a relationship between symptoms and quality of life for persons living with HIV/AIDS. This article reports symptom prevalence and intensity data that include gynecological and cognitive symptoms self-reported by HIV-infected women (N = 118). Using a cross-sectional, descriptive design, data were obtained using the Center for Epidemiological Studies-Depression Scale (CES-D), Medical Outcomes Study Short Form-36 (MOS SF-36), and the revised Sign and Symptom Check-List for Persons Living with HIV/AIDS (SSC-HIV). Prevalent symptoms were depression (83%), muscle aches (84%), weakness (80%), and painful joints (71%). Symptoms with the highest mean intensity, however, were headaches, rash, insomnia, vaginal itching, and shortness of breath at rest. Symptoms also significantly predicted role functioning. This study contributes to our understanding the nature of symptoms and the influence of symptoms on role and physical functioning among HIV-infected women.
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Affiliation(s)
- Angela Hudson
- Department of Nursing, California State University, Fresno, USA
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Feldt T, Oette M, Goebels K, Wenning M, Kroidl A, Häussinger D. Haemodynamic crisis and reversible multiorgan failure caused by HIV post-exposure prophylaxis after needle-stick injury in a health care worker. HIV Med 2004; 5:125-7. [PMID: 15012653 DOI: 10.1111/j.1468-1293.2004.00189.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We report the case of a 59-year-old nurse from our HIV ward who developed a severe haemodynamic crisis with concomitant acute multiorgan failure after initiation of a post-exposure prophylaxis (PEP) with zidovudine/lamivudine (CombivirTM) and lopinavir/ritonavir (KaletraTM) after a needle-stick injury with an HIV-contaminated needle. Although serious and life-threatening adverse effects of post-exposure prophylaxis have been documented in several cases, this is the first report of a severe acute cardiovascular incident following PEP initiation.
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Affiliation(s)
- T Feldt
- Department of Gastroenterology, Hepatology and Infectiology, Heinrich Heine University, Dusseldorf, Germany.
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Affiliation(s)
- Ingrid Schmid
- David Geffen School of Medicine, University of California Los Angeles, Department of Hematology/Oncology, Los Angeles, California 90095, USA
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Barroso J, Carlson JR, Meynell J. Physiological and psychological markers associated with HIV-related fatigue. Clin Nurs Res 2003; 12:49-68. [PMID: 12583499 DOI: 10.1177/1054773803238740] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fatigue is among the most common and debilitating complaints of HIV-positive individuals. These data are part of a larger exploratory study investigating the relationships of selected psychological and physiological factors among 40 participants with HIV-related fatigue. Fatigue severity was measured using the HIV-Related Fatigue Scale. Fatigue was correlated with depression (r = .40, p < .01), state anxiety (r = .40, p <.01), and trait anxiety (r = .46, p <.01). Of the physiological factors, there were three statistically significant correlations: thyroid-stimulating hormone was negatively correlated with fatigue severity (r = -.36, p = .02), and platelets (r = .35, p = .03) and alkaline phosphatase (r = .27, p = .09) were positively correlated with fatigue severity. There were no correlations between fatigue severity and CD4 count (r = -.16, p = .31) or fatigue severity and HIV viral load levels (r = .031, p = .84). Even among the group with excellent viral suppression, fatigue scores were still very high for many participants.
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Do AN, Ciesielski CA, Metler RP, Hammett TA, Li J, Fleming PL. Occupationally acquired human immunodeficiency virus (HIV) infection: national case surveillance data during 20 years of the HIV epidemic in the United States. Infect Control Hosp Epidemiol 2003; 24:86-96. [PMID: 12602690 DOI: 10.1086/502178] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To characterize occupationally acquired human immunodeficiency virus (HIV) infection detected through case surveillance efforts in the United States. DESIGN National surveillance systems, based on voluntary case reporting. SETTING Healthcare or laboratory (clinical or research) settings. PATIENTS Healthcare workers, defined as individuals employed in healthcare or laboratory settings (including students and trainees), who are infected with HIV. METHODS Review of data reported through December 2001 in the HIV/AIDS Reporting System and the National Surveillance for Occupationally Acquired HIV Infection. RESULTS Of 57 healthcare workers with documented occupationally acquired HIV infection, most (86%) were exposed to blood, and most (88%) had percutaneous injuries. The circumstances varied among 51 percutaneous injuries, with the largest proportion (41%) occurring after a procedure, 35% occurring during a procedure, and 20% occurring during disposal of sharp objects. Unexpected circumstances difficult to anticipate during or after procedures accounted for 20% of all injuries. Of 55 known source patients, most (69%) had acquired immunodeficiency syndrome (AIDS) at the time of occupational exposure, but some (11%) had asymptomatic HIV infection. Eight (14%) of the healthcare workers were infected despite receiving postexposure prophylaxis (PEP). CONCLUSIONS Prevention strategies for occupationally acquired HIV infection should continue to emphasize avoiding blood exposures. Healthcare workers should be educated about both the benefits and the limitations of PEP, which does not always prevent HIV infection following an exposure. Technologic advances (eg, safety-engineered devices) may further enhance safety in the healthcare workplace.
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Affiliation(s)
- Ann N Do
- Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Center for Disease Control and Prevention, 1600 Clifton Road NE, MS E-47, Atlanta, GA 30333, USA
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Abstract
Bloodborne pathogens pose a continuing threat to healthcare workers. The frequency of needlesticks and wounds from other sharps has been reduced by the use of safety devices in many healthcare workplaces but it has not been eliminated. The need for appropriate management of a needlestick or other exposure that could carry a bloodborne pathogen has become increasingly clear as more is learned about the factors affecting transmission of these infectious agents. With better diagnostic tools and more therapeutic agents the success rate of postexposure prophylaxis (PEP) will continue to improve. This article will focus on those agents as they pose the greatest known threats and offer the potential for intervention.
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Affiliation(s)
- Alan D Tice
- Department of Internal Medicine, John A Burns School of Medicine, University of Hawaii, USA
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Yánez L, Hernández JL, Saiz N, Calvo J, Ramos C, Salesa R, González-Macías J. Geotrichum proctitis after HIV postexposure prophylaxis. AIDS 2002; 16:1701-2. [PMID: 12172101 DOI: 10.1097/00002030-200208160-00025] [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: 11/26/2022]
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Luzzati R, Crosato IM, Mascioli M, Valencich A, Giacomazzi D. Galactorrhoea and hyperprolactinemia associated with HIV postexposure chemoprophylaxis. AIDS 2002; 16:1306-7. [PMID: 12045505 DOI: 10.1097/00002030-200206140-00022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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