HIV postexposure prophylaxis after sexual assault

Recent advances in the treatment of human immunodeficiency virus (HIV) disease have prompted health care providers to reexamine recommendations for prophylaxis of HIV infection. Parallels with occupational exposure through mucous membrane tissues spur consideration of HIV prophylaxis after sexual assault for several reasons. In both instances, exposure occurs at a single point in time and is unlikely to recur. Although the Centers for Disease Control and Prevention does not make definitive recommendations regarding postexposure prophylaxis after sexual assault, the reality is that as clinicians, we face situations in which we must consider treatment for prevention of HIV disease after sexual assault. Guidelines for treatment and how to create and implement a policy to ensure the best outcomes, and provide a high quality of patient care with the New York State guidelines as a model, are discussed.     

HIV postexposure prophylaxis for children and adolescents

HIV postexposure prophylaxis (PEP) is now a well-established part of the management of health care workers after occupational exposures to HIV. Use of PEP for adults exposed to HIV after sexual contact or injection drug use in nonoccupational settings remains controversial with limited data available. There is even less information available concerning HIV PEP for children and adolescents after accidental needlestick injuries or sexual assault. The objective was to describe the current practice of and associated problems with HIV PEP for children and adolescents at an urban academic pediatric emergency department. A retrospective review of all children and adolescents offered HIV PEP between June 1997-June 1998 was conducted. Ten pediatric and adolescent patients were offered HIV PEP, six patients after sexual assault, four patients after needle stick injuries. There were two small children 2 and 3 years of age and eight adolescents. Of these 10 patients, eight were started on HIV PEP. The regimens used for PEP varied; zidovudine, lamivudine, and indinavir were prescribed for in seven patients and zidovudine, lamivudine, and nelfinavir for one other. All 10 patients were HIV negative by serology at baseline testing and all available for follow-up testing (5 of 10) remained HIV negative at 4 to 28 weeks. Only two patients completed the full course of 4 weeks of antiretroviral therapy. Financial concerns, side effects, additional psychiatric and substance abuse issues as well as the degree of parental involvement influenced whether PEP and clinical follow-up was completed. HIV PEP in the nonoccupational setting for children and adolescents presents a medical and management challenge, and requires a coordinated effort at the initial presentation to the health care system and at follow-up. The difficulties encountered in the patients in our series need to be considered before initiating prophylaxis. A provisional management approach to HIV PEP in children and adolescents is proposed.     

艾滋病与HIV的职业暴露后防护

艾滋病即获得性免疫缺陷综合征(acquired immunodeficiency syndrome，AIDS)是由人类免疫缺陷病毒(Human Immunodeficiency Vires，HIV)引起的一种严重的传染病。HIV病毒是一种RNA(核糖核酸)逆转录病毒，属慢病毒(Lentivirinae)。HIV主要型别为HIV-1和HIV-2，我国艾滋病大多由HIV-1引起。     

Surveillance of HIV exposure and postexposure prophylaxis among health care workers in Greece

OBJECTIVE: Many developed countries have implemented surveillance systems for monitoring occupational exposure to HIV. The aim of the present study was to analyze surveillance data on HIV postexposure prophylaxis (PEP) for health care workers (HCWs) in Greece. DESIGN: All data reported to the Hellenic Centre for Disease Control and Prevention between January 1996 and June 2005 were analyzed. SAMPLE AND MEASUREMENT: 188 reported occupational exposures to HIV were analyzed, retrospectively. RESULTS: Most exposures were in the physicians (37.8%), followed by the nursing personnel (18.6%). Nearly 38% of the HCWs were males and the predominant type of biological material involved in the exposure was blood (74.5%). Two drugs were used for PEP in 23.4% of the HCWs, and 3 drugs in 66.5% of the reported cases. CONCLUSIONS: Greek guidelines provide guidance for treating HCWs after occupational exposure to HIV. In our study, antiretroviral treatment, a three-drug regimen in the majority of the cases, was prescribed after evaluation of specially appointed physicians. The surveillance system of occupational exposure to HIV in HCWs should be further developed and enhanced in order to monitor and evaluate the risk factors surrounding the incidents.     

Testing for HIV: current practices in the academic ED.

The objective of this study was to determine common practices for testing for Human Immunodeficiency Virus (HIV), particularly in patients with other sexually transmitted diseases (STD) in emergency departments (ED) with residency training in Emergency Medicine. Via mail, 112 directors of academic emergency medicine programs in the United States were surveyed. Surveys from 95 academic institutions were completed, returned, and included in the analysis. Three EDs (3%) routinely tested for HIV in patients with suspected STD. HIV testing was performed in the ED in 54% of responding institutions under special circumstances such as employee testing after occupational exposures (54%), cases of rape (46%), and suspicion of HIV infection by clinical manifestations other than suspected STD (36%). Based on the results it was determined that academic EDs do not routinely test for HIV in patients suspected of having a STD and have variable testing practices and policies regarding other possible HIV exposures.     

Viral hepatitis. Preexposure and postexposure prophylaxis.

Rational strategies for preventing viral hepatitis are being developed as the epidemiology of the disease is becoming better defined. A vaccine is available only for hepatitis B. Other prophylactic strategies are based on avoidance of high-risk behavior and use of immune globulin. Universal vaccination for hepatitis B is now recommended.     

Evaluation of state-provided postexposure prophylaxis against rabies in Florida

BACKGROUND: One key component of human rabies prevention is the use of postexposure prophylaxis (PEP). No information is routinely available to evaluate the appropriateness of this intervention. METHODS: A survey queried county health departments regarding rabies PEP administered during July through September in 1997 and in 1998. RESULTS: A total of 160 cases meeting the study criteria were characterized. Domestic animals accounted for most potential rabies exposures. Nearly a quarter of the reports indicated that PEP was not necessary. Health departments collected just over 25% of costs for antirabies biologics. CONCLUSIONS: Human rabies prevention systems can be enhanced by reducing the number of PEP events through improved recovery of biting animals. Inappropriate administration of PEP and cost can be reduced by establishing a system of after-the-fact review of every episode of PEP with timely feedback to providers.