Occupational HIV infection among health care workers exposed to blood and body fluids in Brazil

BACKGROUND: Exposure to bloodborne pathogens poses a serious risk to health care workers (HCWs). Surveillance systems of occupationally acquired human immunodeficiency virus (HIV) infection have been developed in several countries, mainly in the developed world. The purpose of this study was to identify cases of occupationally acquired HIV infection among HCWs in Brazil. METHODS: A systematic literature review was conducted. The databases searched were MEDLINE and LILACS (1981 to 2004), academic dissertations and theses (1987 to 2004), abstracts from national and international meetings during the last 10 years, and local and national bulletins. Reference lists to identify other relevant articles were checked. RESULTS: The database searches generated a total of 60,770 titles. Two hundred and nineteen references were finally analyzed. Four documented cases of occupational HIV infection were identified. All of the cases involved nursing staff and were percutaneous exposures. Seventy-five percent occurred after a procedure involving a needle placed directly into a vein or artery. Most (75%) had source patients with probable high viral load and low CD4 count. Two cases represented HIV seroconversion despite initiation of postexposure prophylaxis. Only one case (1/4; 25%) presented acute retroviral illness. CONCLUSION: After an extensive literature search, 4 documented occupational HIV infection cases were identified, only 1 of which had been published in a scientific journal. Our findings were consistent with the majority of documented infections worldwide. Surveillance systems are indispensable to establish and formulate rational policies for minimizing the risk of occupational infection, not only from HIV but also from hepatitis B and C viruses and other bloodborne pathogens.     

Mandatory pre-marital HIV testing in Nigeria: the public health and social implications

The prevalence of HIV infection among individuals referred from faith-based organizations (FBOs) in south-eastern Nigeria for mandatory pre-marital HIV screening was determined. Of the total of 319 individuals (148 males, 171 females) screened, 25 (7.8%, 95%CI: 4.9-10.7%) were confirmed HIV-positive, comprising 13 (8.8%, 95%CI: 4.2-13.4%) males and 12 (7%, 95%CI: 3.2-10.8%) females. No significant difference was observed in the association between HIV infection and gender (chi2=0.58, df = 1, P < 0.05). The highest prevalence of HIV infection (8.9%) was recorded among individuals in the 21-30 years age category, while the least HIV infection prevalence (5.3%) was observed among persons above 40 years old. There was no significant difference in the association between HIV infection and age (chi2=0.68, df = 3, P < 0.05). Mandatory pre-marital HIV screening could generate social stigmatization and infringement of the fundamental human rights of infected individuals. Voluntary counselling and confidential HIV testing and especially pre- and post-test counselling as the basis of pre-marital HIV testing are more desirable. Guidelines for the management of test-positive individuals and non-concordant couples and the safeguarding of confidentiality should be developed. Training and capacity building for religious leaders, to appropriately manage social issues associated with HIV/AIDS as it affects their organizations, are recommended.     

Dynamics of HIV viremia and antibody seroconversion in plasma donors: implications for diagnosis and staging of primary HIV infection

OBJECTIVES: The characterization of primary HIV infection by the analysis of serial plasma samples from newly infected persons using multiple standard viral assays. DESIGN: A retrospective study involving two sets of archived samples from HIV-infected plasma donors. (A) 435 samples from 51 donors detected by anti-HIV enzyme immunoassays donated during 1984-1994; (B) 145 specimens from 44 donors detected by p24 antigen screening donated during 1996-1998. SETTING: Two US plasma products companies. MAIN OUTCOME MEASURES: The timepoints of appearance of HIV-1 markers and viral load concentrations during primary HIV infection. RESULTS: The pattern of sequential emergence of viral markers in the 'A' panels was highly consistent, allowing the definition and estimation of the duration of six sequential stages. From the 'B' panels, the viral load at p24 antigen seroconversion was estimated by regression analysis at 10 000 copies/ml (95% CI 2000-93 000) and the HIV replication rate at 0.35 log copies/ml/day, corresponding to a doubling time in the preseroconversion phase of 20.5 h (95% CI 18.2-23.4 h). Consequently, an RNA test with 50 copies/ml sensitivity would detect HIV infection approximately 7 days before a p24 antigen test, and 12 days before a sensitive anti-HIV test. CONCLUSION: The sequential emergence of assay reactivity allows the classification of primary HIV-1 infection into distinct laboratory stages, which may facilitate the diagnosis of recent infection and stratification of patients enrolled in clinical trials. Quantitative analysis of preseroconversion replication rates of HIV is useful for projecting the yield and predictive value of assays targeting primary HIV infection.     

Fatal disseminated toxoplasmosis during primary HIV infection

Toxoplasmosis is a well recognized manifestation of AIDS, but the disseminated disease is a rare condition and it has not been associated to HIV seroconversion to our knowledge. We describe a fatal episode of disseminated T. gondii acute infection with massive organ involvement during primary HIV infection. The serological data demonstrate primary T. gondii infection. The avidity index for HIV antibodies supports recent HIV-1 infection.     

Topiramate reduces the harm of excessive drinking: implications for public health and primary care

AIMS: Having demonstrated previously the efficacy of topiramate--a sulfamate-substituted fructopyranose derivative-as pharmacotherapy for treating alcohol dependence, promoting abstinence and reducing the harmful psychosocial consequences of drinking, we investigated whether topiramate also promoted 'safe' levels of drinking: < or = 1 and < or = 2 standard drinks/day for women and men, respectively, among alcohol-dependent individuals. DESIGN, SETTING AND PARTICIPANTS: In a double-blind, randomized, controlled, 12-week clinical trial conducted in San Antonio, Texas, 75 alcohol-dependent adults received topiramate and 75 received placebo as an adjunct to weekly standardized medication compliance management. MEASUREMENTS: For this secondary analysis of data from that trial, we calculated, based on self-reports, specific intervals of up to 30 days of continuous 'safe' drinking for each subject. FINDINGS: The average longest 'safe' drinking period was 16.7 days for topiramate recipients versus 8.9 days for placebo recipients. By day 50 of treatment, 44% versus 26.4% had achieved > or = 7 and 30.8% versus 10% had achieved > or = 14 continuous 'safe' drinking days. Similarly, topiramate increased the relative likelihood of continuous 'safe' drinking from 77% for > or = 7 days [relative risk (RR) for achieving continuous 'safe' drinking = 1.77] to threefold for > or = 14 days (RR = 3.37) and fourfold for > or = 28 days (RR = 4.07). Thus, participants who received topiramate were more likely to achieve longer periods of 'safe' drinking compared with those who received placebo. CONCLUSIONS: For alcohol-dependent individuals who drank within an abstinence-oriented treatment program, topiramate promoted 'safe' drinking. Topiramate's potential to decrease the public health consequences of hazardous drinking needs to be established in future long-term studies.     

Acute ventricular fibrillation during primary HIV infection

Primary HIV infection normally shows an asymptomatic presentation or symptoms resembling infectious mononucleosis. However, severe unusual presentations have been reported. We report a case of acute ventricular fibrillation during primary HIV infection. Moreover, the rapid development of symptoms, the profound pancytopaenia and the marked elevation of liver enzymes make this case rather unique. Therefore, acute ventricular fibrillation should be added to the list of complications of primary HIV infection.     

Sexual dysfunction in gay and bisexual men with HIV infection: evaluation, treatment and implications

Sexual dysfunction problems are common in people with HIV infection, but their relevance has been recently highlighted in response to the increased survival shown by many individuals with HIV, and the publicity surrounding the development of new treatments for male sexual dysfunction. Thirty-four gay/bisexual men with HIV infection presenting with sexual dysfunction were assessed. Antiretroviral combination therapy including protease inhibitors was taken by 44%, other combinations not including protease inhibitors by 24%, while 32% were not taking any antiretrovirals. Primarily psychogenic sexual dysfunction was thought to be present in 44%, primarily organic dysfunction in 22% and a mixed aetiology in 34%. Treatments offered included psychological interventions and physical methods of treatment, alone or in combination. Treatment was effective, with 76% reporting resolution of the problems, 14% reporting improvement and only 10% reporting no change. Practical and ethical issues raised by the findings are discussed.     

Burkholderia cepacia epidemiology and pathogenesis: implications for infection control

Much has been learned during the past 2 years about the microbiology and taxonomy of Burkholderia cepacia. Several distinct species have been identified in what is now referred to as the B. cepacia complex. Preliminary studies indicate that certain of these species are more likely to colonize and cause severe pulmonary infection in persons with cystic fibrosis. Ongoing investigations will expand these findings and have the potential to modify current infection control policies. The commercial use of B. cepacia as an antifungal biopesticide and in bioremediation has attracted increasing attention from industry recently and raises concerns within the cystic fibrosis community. Consensus regarding the potential threat of such uses to cystic fibrosis patients is being sought by governmental agencies and agricultural and biomedical researchers.     

Inclusion body myositis: diagnosis, pathogenesis, and treatment options

Inclusion body myositis (IBM) is the most common acquired myopathy in people older than 50 years. IBM typically presents with distal upper extremity weakness accompanied by proximal lower extremity muscle weakness. Associated clinical findings include asymmetric weakness, foot drop, and dysphagia. The pathogenesis of IBM is not clear. In this article the authors briefly discuss postulated pathogenic mechanisms. Although no proven pharmacotherapy exists, some promising candidates are discussed.     

Capillary leakage in travelers with dengue infection: implications for pathogenesis

Dengue hemorrhagic fever is characterized by the presence of a capillary leak syndrome. Its pathogenesis is presumed to differ from that of classical dengue fever (DF) and to be associated with secondary dengue infection. Returning travelers given a diagnosis of DF were evaluated for capillary leakage with abdominal sonography. Data were compared between travelers with primary/secondary infection defined by epidemiologic and serologic parameters. A total of 12 (34.3%) of 35 patients had sonographic signs of capillary leakage. Most (85%) patients with capillary leakage had classical DF. Capillary leak was diagnosed in 32% of primary dengue cases and in 40% of secondary dengue cases (P = 0.69). The two patients given a diagnosis of dengue hemorrhagic fever had primary infections. The high prevalence of capillary leakage among travelers, most of them with primary exposure to dengue, calls into question the importance of secondary infection in causing capillary leakage in dengue infection.