RESUMEN
We report an extreme case of high-grade needlestick exposure of a health-care worker to serum from multiple HIV-infected patients after trying to prematurely remove the respective tubes from an automated biochemical analyser. After review of the medical records of the eight source patients, we offered the health-care worker an expanded postexposure prophylaxis regimen including the entry inhibitor enfuvirtide. She refused to take subcutaneous injections, so we recommended the use of the integrase inhibitor raltegravir. She completed therapy without problems and periodic evaluation for HIV transmission up to nine months after the incident was negative.
Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Dedos , Infecciones por VIH/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Lesiones por Pinchazo de Aguja , Enfermedades Profesionales/prevención & control , Profilaxis Posexposición/métodos , Adenina/administración & dosificación , Adenina/análogos & derivados , Terapia Antirretroviral Altamente Activa , Darunavir , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Emtricitabina , Enfuvirtida , Femenino , Proteína gp41 de Envoltorio del VIH/administración & dosificación , Humanos , Persona de Mediana Edad , Enfermedades Profesionales/virología , Organofosfonatos/administración & dosificación , Fragmentos de Péptidos/administración & dosificación , Ritonavir/administración & dosificación , Sulfonamidas/administración & dosificación , TenofovirRESUMEN
The prevalence of hepatitis B virus (HBV) infection in Cyprus was estimated in a sample of 795 blood donors, 388 armed forces recruits, 1872 hospital staff, 135 haemodialysis patients, 559 thalassaemic patients, 722 institutionalised adults, 98 mentally retarded children and 323 family contacts of HBsAg carriers. Commercially available radioimmunoassays were used for screening. Merck Sharpe and Dohme hepatitis B vaccine was used for a vaccination pilot program. Our results showed that the carrier rate of HBsAg in the blood donor and army recruit samples ranged between 0.77% and 1.01% and the prevalence of past infection between 11.1% and 13.6%. Among high risk groups the highest carrier rate was found in family contacts of HBsAg carriers (18.27%), in mentally retarded children (6.12%) and in institutionalized adult patients (5.40%). The frequency of immunes was found 28.5%, 12.2% and 33.2% respectively. The highest frequency of immunes was found in thalassaemic (82.9%) and haemodialysis (43.7%) patients. The carrier rate (2.94%) and the prevalence of immunes (22.5%) in hospital personnel was higher than in general population. Vaccination studies in a limited number of thalassaemic children and hospital personnel showed excellent acceptance of vaccination and excellent immunogenicity. We infer that HBV infection should be consider as a major public health problem in Cyprus. A National Vaccination program has to be implemented for containing its spread.
Asunto(s)
Hepatitis B/epidemiología , Adulto , Donantes de Sangre , Portador Sano/epidemiología , Chipre , Hepatitis B/prevención & control , Anticuerpos contra la Hepatitis B/análisis , Antígenos de Superficie de la Hepatitis B/análisis , Antígenos de Superficie de la Hepatitis B/inmunología , Vacunas contra Hepatitis B , Humanos , Personal Militar , Vacunación , Vacunas contra Hepatitis Viral/administración & dosificaciónRESUMEN
The prevalence of HBV, HDV and HIV infection was studied in 288 imprisoned intravenous drug addicts (IVDA) and 329 controls. Commercially available radioimmunoassays for the detection of HBV and HDV serologic markers and enzyme-immunoassays for IgM anti-HBc and anti-HIV were used. Anti-HIV positive results were confirmed by Western Blot. The prevalence of HBV serologic markers among IVDA (77.1%) was found considerably higher than among controls (22.5%). An increased prevalence of HBsAg carriers (6.9%) and anti-HBc alone positives (9.7%) was also found. IVDA carriers were more frequently HBeAg positive (25.0%) and HDV serologic markers were detected in 35.0% (7/20) of them. Anti-HIV were detected in 6 (2.1%) IVDA but in none control. These data show the widespread HBV and HDV infections among Greek IVDA and suggest the need for continuation of the initiated hepatitis B vaccination program. Anti-HIV prevalence is yet low. However there is urgent need for an extensive campaign to limit the further spread of the HIV among this high risk group.