Serological studies on health care workers caring for patients with human immunodeficiency virus

Between 1982 and July 1987, more than 1200 patients attending St Stephen's Hospital were found to be HIV antibody positive. Four hundred were inpatients and most of the outpatients attended the sexually transmitted disease clinic. Two hundred and twenty-one patients had AIDS, 480 HIV-related disorders and 500 were asymptomatic. Most inpatients had invasive procedures within the operating theatres and there were 25 postmortems. Four hundred and five antibody tests from 220 health care workers from the STD clinic, operating theatres, isolation ward, intensive care unit and clinical laboratories were voluntarily tested for HIV antibody by an ELISA screening method. All were negative, except one male nurse who had other risk factors. Twenty-nine staff suffered needlestick injury with blood of HIV antibody positive patients; none has developed serological evidence of HIV infection.     

Surveillance of occupational blood and body fluid exposures among French healthcare workers in 2004.

OBJECTIVE: To estimate the incidence rate of reported occupational blood and body fluid exposures among French healthcare workers (HCWs). DESIGN: Prospective national follow-up of HCWs from January 1 to December 31, 2004. SETTING: University hospitals, hospitals, clinics, local medical centers, and specialized psychiatric centers were included in the study on a voluntary basis. PARTICIPANTS: At participating medical centers, every reported blood and body fluid exposure was documented by the occupational practitioner in charge of the exposed HCW by use of an anonymous, standardized questionnaire. RESULTS: A total of 375 medical centers (15% of French medical centers, accounting for 29% of hospital beds) reported 13,041 blood and body fluid exposures; of these, 9,396 (72.0%) were needlestick injuries. Blood and body fluid exposures were avoidable in 39.1% of cases (5,091 of 13,020), and 52.2% of percutaneous injuries (4,986 of 9,552) were avoidable (5.9% due to needle recapping). Of 10,656 percutaneous injuries, 22.6% occurred during an injection, 17.9% during blood sampling, and 16.6% during surgery. Of 2,065 splashes, 22.6% occurred during nursing activities, 19.1% during surgery, 14.1% during placement or removal of an intravenous line, and 12.0% during manipulation of a tracheotomy tube. The incidence rates of exposures were 8.9 per 100 hospital beds (95% confidence interval [CI], 8.7-9.0 exposures), 2.2 per 100 full-time-equivalent physicians (95% CI, 2.4-2.6 exposures), and 7.0 per 100 full-time-equivalent nurses (95% CI, 6.8-7.2 exposures). Human immunodeficiency virus serological status was unknown for 2,789 (21.4%) of 13,041 patients who were the source of the blood and body fluid exposures. CONCLUSION: National surveillance networks for blood and body fluid exposures help to better document their characteristics and risk factors and can enhance prevention at participating medical centers.     

单剂量Nevirapine母婴阻断与HIV

全球艾滋病的流行形势日趋严重,2007年15岁以下儿童感染者为250万,其中大部分是母婴传播,新感染人数为42万,死亡人数为33万,妇女艾滋病感染者为1540万[1].如果不接受抗病毒治疗,HIV感染儿童的预后很不乐观,大约有50%儿童在2周岁之前死亡[2,3].     

Nosocomial infection among children with symptomatic human immunodeficiency virus infection.

A prospective cohort study was conducted during a 15-month period to compare nosocomial infections (NIs) among pediatric patients without (n = 989 and with (n = 50) symptomatic human immunodeficiency virus (HIV) infection. Patients with symptomatic HIV infection presented higher overall NI incidence density rates (relative risk, 1.65; P= .0001), and may represent a population at high risk for the acquisition of NI.     

Infection with human immunodeficiency virus and hepatitis viruses in Chinese drug addicts.

The prevalence of antibody against hepatitis C virus (anti-HCV) and five hepatitis B virus markers (HBVM) was measured in 176 Chinese drug addicts, of whom 23 were AIDS patients. Of 176 drug addicts, 147 were members of ethnic minorities while 29 were Han, the majority ethnic group. The total prevalence rates of anti-HCV and HBVM were 35.8% and 50.6% respectively, significantly different (P < 0.01). Anti-HCV and HBVM were together found in 22.7%. Similar prevalence rates were found among the different ethnic groups. Among the ethnic minorities, there was a significantly higher prevalence rate of anti-HCV in intravenous drug addicts (IVDA, 51.1%) than in oral drug addicts (20.3%). Furthermore, the prevalence of anti-HCV was significantly higher in needle-sharing abusers (60.4%) than in non-needle sharing ones (37.1%, P < 0.05). The prevalence of HBVM was also significantly higher in needle-sharing abusers (69.8%) than in non-needle sharing ones (34.3%). Prevalence of HBsAg was significantly higher in drug abusers with AIDS (47.8%) than in IVDA only (16.1%). The anti-HCV positive rates among ethnic minority people were: for the Yi people 69.2%, the Hui 55.6%, the Bai 53.9%, the Dai 26.8% and the Wa 23.1%. No obvious difference was identified for HBVM. The prevalence rates of HCV, HBV and HCV + HBV in IVDA showed no significant difference (P > 0.05) between the two regions. HIV, HCV and HBV infections may promote each other and be related to needle-sharing behaviour in drug abuse and to different subcultures and living habits.     

Prevalence of antibodies to human immunodeficiency virus among intravenous drug users in Israel--association with travel abroad

A serological survey of 400 Israeli intravenous drug users showed a 2% prevalence of antibodies to human immunodeficiency virus (HIV). No difference was found between seropositive and seronegative subjects regarding mean age, duration of intravenous drug use, and needle sharing. Seropositivity was, however, significantly associated with travel abroad since 1980 (P less than 0.001), and with intravenous drug injection abroad (P = 0.04). These data indicate that Israel is a pre-endemic area for HIV infection, and transmission of the virus among Israeli intravenous drug users seems to be infrequent at the current level of exposure.     

Behavioural and serological human immunodeficiency virus risk factors among female commercial sex workers in Cambodia

BACKGROUND: The spread of human immunodeficiency virus (HIV) in Cambodia is mainly caused by sexual transmission and the high-risk group in this country are female commercial sex workers (CSW). There are two types of CSW, direct CSW (DCSW) and indirect CSW (IDCSW), who are different from each other in sexual activities. This study was conducted in order to describe the risk factors on HIV for each type of CSW, and to establish effective preventive strategies against the HIV epidemic among CSW. METHODS: The participants, 143 DCSW and 94 IDCSW, were interviewed using a questionnaire to determine their demographic characteristics and behaviour. Blood samples were taken for serological tests on HIV, Chlamydia trachomatis and syphilis. The association between their behavioural pattern and their serological results was analysed. RESULTS: The questionnaire study showed that IDCSW had a riskier behavioural pattern than DCSW. The HIV seroprevalence rates of the DCSW and the IDCSW were 52.4% and 22.3%, respectively. Univariate logistic analyses showed a significant association between HIV antibody (HIV-Ab) and current age, age at commencement of commercial sex work, duration of commercial sex work, and the seropositivity of Chlamydia trachomatis-IgG antibody (CT-IgG-Ab) among the DCSW. The analyses also showed a significant relationship between HIV-Ab and CT-IgG-Ab among the IDCSW. CONCLUSIONS: Improving condom use rate is very important in order to prevent an HIV epidemic among the two types of CSW. This study also suggests it is important to prevent sexually transmitted disease (STD) such as Chlamydia trachomatis infection. The STD control programme could be efficient for HIV prevention, especially among DCSW.     

Collaborative education regarding prevention of human immunodeficiency virus transmission in healthcare settings--Ghana.

OBJECTIVE: To evaluate the effectiveness of a collaborative and participatory approach to professional training to reduce the risk of human immunodeficiency virus (HIV) transmission. SETTING: Healthcare settings in Ghana. METHODS: Two 5-day workshops were conducted for high-level nurse educators and leaders who could contribute to national policy development. A combination of didactics, skill development sessions, field experiences, and development of draft national guidelines and curriculum were used. Outcomes evaluated were pre-to-post training changes in HIV knowledge and attitudes and changes in practice within selected healthcare settings. One-month follow-up visits (times not specified to participants) were used to evaluate outcomes. RESULTS: At post-test, significantly fewer participants thought HIV was transmitted by saliva, sweat, or tears (chi square, p less than .0001), and significantly fewer reported hesitation to care for an HIV-infected patient because of lack of understanding about mode of transmission or because of lack of supplies, such as gloves (chi square, p less than .01). In field observations, there was an overall 42% improvement in specific infection control practices. CONCLUSIONS: A collaborative and participatory approach to training can result in significant changes in infection control practices, even in settings with limited resources.     

Outpatient management of patients infected with human immunodeficiency virus.

The outpatient management of patients infected with human immunodeficiency syndrome is reviewed. Patients with CD4+ cell counts of greater than 0.5 x 10(9)/L (500/mm3) require no specific intervention except vaccination against influenza, pneumococcus, and possibly hepatitis B. They should have a follow-up examination every 3 to 6 months. Because of its success in preventing the progression of the disease, zidovudine (AZT), 100 mg five times per day, is recommended for patients with CD4+ cell counts of less than 0.5 x 10(9)/L (500/mm3). During this stage of the disease, a patient should be seen every 1 to 3 months and monitored for drug toxicity and disease progression. Patients with CD4+ counts of less than 0.2 x 10(9)/L (200/mm3) are at high risk of developing Pneumocystis carinii pneumonia. Prophylaxis with oral trimethoprim-sulfamethoxazole (one double-strength tablet three times weekly) or dapsone (100 mg three times weekly) is recommended. Treatment costs for the patient with CD4+ cells less than 0.5 x 10(9)/L (500/mm3) are at least $3000 per year.     

Recent decline in the incidence of human immunodeficiency virus infection among California men who have sex with men

Monitoring the incidence of human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is imperative for developing targeted prevention programs and evaluating their effectiveness. The authors used California counseling and testing data to estimate the temporal trend in HIV incidence among MSM in California. HIV incidence rates were retrospectively calculated among MSM who had received at least 1 HIV test at a public California counseling and testing site between 1997 and 2007 and had a prior HIV-negative test from any HIV testing source. All study subjects were weighted on the basis of the interval between the last HIV-negative test and the current HIV test to account for the right-truncation bias introduced by more frequent testers. The authors observed that the HIV incidence rate among MSM in California increased from 2.0/100 person-years (95% confidence interval (CI): 1.8, 2.2) in 1997 to 2.4/100 person-years (95% CI: 2.2, 2.6) in 2003 and then decreased to 1.9/100 person-years (95% CI: 1.7, 2.0) in 2006. Trend analyses showed that both the increase (P < 0.001) and the decrease (P < 0.01) were statistically significant. The study showed that HIV incidence among MSM in California had decreased since 2003.     

Control of occupational hepatitis B among healthcare workers in the Czech Republic, 1982 to 1995.

Occupational hepatitis B remains a threat to healthcare workers (HCWs) worldwide, even with availability of an effective vaccine. Despite limited resources for public health, the Czech Republic instituted a mandatory vaccination program for HCWs in 1983. Annual incidence rates of acute hepatitis B were followed prospectively through 1995. Despite giving vaccine intradermally from 1983 to 1989 and intramuscularly as half dose from 1990 to 1995, rates of occupational hepatitis B decreased dramatically, from 177 cases per 100,000 workers in 1982 (before program initiated) to 17 cases per 100,000 in 1995. Among high-risk workers, the effect was even more dramatic (from 587 to 23 per 100,000). We conclude that strong public-health leadership led to control of occupational hepatitis B among HCWs in the Czech Republic, despite limited resources that precluded administering full-dose intramuscular vaccine for much of the program. Application of a similar program should be considered for other countries in regions that currently do not have a hepatitis B vaccination program.     

A cluster of primary varicella cases among healthcare workers with false-positive varicella zoster virus titers.

BACKGROUND: Five cases of primary varicella zoster virus (VZV) we re diagnosed among hospital healthcare workers (HCWs). All had complied with a pre-employment VZV screening program and had been considered immune. OBJECTIVES: To summarize the investigation of VZV among un-immunized HCWs and to provide recommendations for avoiding false-positive serologic tests. DESIGN: Risk of transmission of VZV to susceptible HCWs is minimized through serologic screening. Varicella vaccine is recommended for susceptible HCWs. A commercially available latex bead agglutination assay (LA) is widely used because it is rapid and easy to perform. LA was compared with the whole-cell varicella ELISA standardized in the Centers for Disease Control and Prevention (CDC) National Herpes Laboratory. SETTING/POPULATION: Large inner-city, tertiary-employee population. RESULTS: In a year, 5 HCWs presented with laboratory-confirmed primary varicella infection. Four had VZV exposures 2 weeks prior to presentation. All had documented positive VZV titers by LA performed at hire. None were offered VZV vaccination. The original LAs were judged false-positives. INTERVENTION/FOLLOW-UP INVESTIGATION: Fifty-three consecutive VZV LA samples from the hospital laboratory were retested at the CDC. Forty-four samples concurred. Of the remaining 9, 4 were positive by hospital LA but negative by CDC IgG ELISA. Four were equivocal by hospital LA but negative by CDC IgG ELISA and LA. One was positive by hospital LA but negative by LA and equivocal by ELISA at the CDC. CONCLUSION: LA may be prone to false-positive results and inappropriate for screening hospital HCWs.     

Undiagnosed AIDS in patients with progressive dyspnoea: an occupational risk for healthcare workers in Croatia

Pulmonary diseases are well documented and diverse in many patients with HIV in clinical stages 3 and 4. It is not unusual that these patients, most of whom do not know that they are already HIV-infected, are first examined and hospitalised by respiratory medicine specialists. While HIV-infection is relatively simple to diagnose if accompanied by advanced clinical manifestations and is regularly checked in patients with increased risk, this is not the case in low-risk patients, particularly in countries with low-level HIV epidemic and therefore low index of suspicion. Regular examination involves a series of tests, often including bronchoscopy with transbronchal lung biopsy in order to identify an interstitial lung disease and/or progressive dyspnoea. It is not uncommon that patients provide false or incomplete information about their lifestyle, which can mislead the clinician. At this point, HIV-infection is usually not suspected and healthcare workers may not strictly be following the safety principles which are otherwise applied when HIV-infection is known or suspect, although universal precautions are routine practice. At this point, the risk of exposure is the highest and HIV-transmission to healthcare workers is the most likely to occur. The cases presented here indicate that patients with progressive dyspnoea, which is typical of interstitial lung diseases, should undergo HIV-testing as a part of good clinical practice, even in a country with low-level HIV epidemic.     

Effectiveness of highly active antiretroviral therapy among injection drug users with late-stage human immunodeficiency virus infection

Highly active antiretroviral therapy (HAART) has been shown to be effective in different populations, but data among injection drug users are limited. Human immunodeficiency virus-infected injection drug users recruited into the Acquired Immunodeficiency Syndrome Link to Intravenous Experiences (ALIVE) Study as early as 1988 were tested semiannually to identify their first CD4-positive T-lymphocyte cell count below 200/microl; they were followed for mortality through 2002. Visits were categorized into the pre-HAART (before mid-1996) and the HAART eras and further categorized by HAART use. Survival analysis with staggered entry was used to evaluate the effect of HAART on acquired immunodeficiency syndrome-related mortality, adjusting for other medications and demographic, clinical, and behavioral factors. Among 665 participants, 258 died during 2,402 person-years of follow-up. Compared with survival in the pre-HAART era, survival in the HAART era was shown by multivariate analysis to be improved for both those who did and did not receive HAART (relative hazards = 0.06 and 0.33, respectively; p < 0.001). Inferences were unchanged after restricting analyses to data starting with 1993 and considerations of lead-time bias and human immunodeficiency viral load. The annual CD4-positive T-lymphocyte cell decline was less in untreated HAART-era participants than in pre-HAART-era participants (-10/microl vs. -37/microl, respectively), suggesting that changing indications for treatment may have contributed to improved survival and that analyses restricted to the HAART era probably underestimate HAART effectiveness.     

Geographic distribution of human immunodeficiency virus markers in parenteral drug abusers.

Drug abuse treatment programs in six regions of the United States collaborated in a study aimed at monitoring trends in the seroprevalence of human immunodeficiency virus (HIV) antibodies. The wide disparities in HIV seroprevalence in the face of similarities in drug using behavior have important implications for prevention. In the New York City area (Harlem, Brooklyn), 61 per cent of samples (N = 280) obtained in late 1986 were positive, up from 50 per cent of samples (N = 585) in early 1985. In Baltimore, Maryland, 29 per cent of samples (N = 184) representing 11 programs were positive. In contrast, samples from programs distant from the Northeast corridor had far lower rates: Denver, Colorado 5 per cent (N = 100); San Antonio, Texas 2 per cent (N = 106); Southern California, 1.5 per cent (N = 413); and Tampa, Florida, 0 per cent (N = 102). Contrary to expectations, there was no corresponding difference in reported lifetime needle sharing experiences, which ranged from 70 per cent in New York to 99 per cent in San Antonio. HIV seropositivity was associated only with geographic location and ethnicity; however, because needle sharing is practiced by parenteral drug abusers in areas where seroprevalence is still relatively low, these areas are potentially vulnerable to the same catastrophic spread seen in the Northeast. A window of opportunity exists where prompt, vigorous, and aggressive efforts at prevention could have major impact.     

What is the dentist's occupational risk of becoming infected with hepatitis B or the human immunodeficiency virus?

Surveys have shown that dentists are reluctant to treat persons infected with the human immunodeficiency virus (HIV). However, dentists are much more willing to treat patients with infectious hepatitis B virus (HBV). This study shows that the annual cumulative risk of infection from routine treatment of patients whose seropositivity is undisclosed is 57 times greater from HBV than from HIV, and that the risk of dying from HBV infection is 1.7 times greater than the risk of HIV infection, for which mortality is almost certain.     

Subtype-specific transmission probabilities for human immunodeficiency virus type 1 among injecting drug users in Bangkok, Thailand.

The Bangkok (Thailand) Metropolitan Administration cohort of injecting drug users (IDUs) consisted of 1,209 IDUs initially seronegative for human immunodeficiency virus (HIV) who were followed from 1995 to 1998 at 15 Administration drug treatment clinics. At enrollment and approximately every 4 months thereafter, participants were assessed for HIV seropositivity. As of December 1998, there were 133 HIV type 1 seroconversions and approximately 2,300 person-years of follow-up. Of the 133 observed seroconversions, specimens from 126 persons were available for subtyping (27 subtype B, 99 subtype E). In this analysis, the authors assessed differences in subtype-specific transmission while controlling for important risk factors. The methodology used accounts for left truncation, interval censoring, and competing risks as well as for time-varying covariates such as each IDU's history of reported frequency of injection and of incarceration. Using plausible epidemiologic assumptions and controlling for behavioral risks, the authors found that a significantly higher transmission probability was associated with subtype E compared with subtype B in this population. Since many epidemiologic, virologic, and host factors can influence HIV transmission, it was difficult to conclude whether these differences in transmission probabilities were due to biologic properties associated with subtype.     

社区静脉吸毒人群人类免疫缺陷病毒感染现状

目的　了解四川省凉山彝族自治州静脉吸毒人群人类免疫缺陷病毒 (HIV)感染率及其危险因素。方法　于 2 0 0 2年 11月 8～ 2 9日 ,以社区招募方式调查凉山彝族自治州地区静脉吸毒人群的社会人口学、静脉吸毒共用注射器具和性行为方式与HIV感染的关系。采集血样进行HIV和梅毒抗体检测。结果　提供知情同意和符合纳入标准的 379人 ,HIV感染率为 11 3% (43人 )。在单因素χ2 分析中 ,民族、近 3个月共用注射器具总次数、近 3个月共用棉球和梅毒感染与HIV感染有关。在多因素logistic回归模型分析中 ,近 3个月共用注射器具总次数 (OR =2 2 8;95 %CI为 1 18～ 4 4 3)和梅毒感染 (OR =3 10 ;95 %CI为 1 4 8～ 6 4 8)与HIV感染有关。结论　近 3个月共用注射器具总次数和梅毒感染与HIV感染有关。