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Antiretroviral Drug Resistance Among Patients With Human Immunodeficiency Virus Who Act as Sources or Potential Sources in Occupational Accidents Involving Healthcare Workers

Fabiane El‐Far , MD, Eduardo Alexandrino Servolo Medeiros , MD, PhD, Carlos Teodoro Gasparoto , MD, PhD and Ricardo Sobhie Diaz , MD, PhD
Infection Control and Hospital Epidemiology
Vol. 26, No. 9 (September 2005), pp. 782-788
DOI: 10.1086/502617
Stable URL: http://www.jstor.org/stable/10.1086/502617
Page Count: 7
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Antiretroviral Drug Resistance Among Patients With Human Immunodeficiency Virus Who Act as Sources or Potential Sources in Occupational Accidents Involving Healthcare Workers
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Abstract

OBJECTIVE.  To determine human immunodeficiency virus (HIV) type 1 genotypic antiretroviral drug resistance profiles of patients presenting a risk or potential risk for occupational exposure of healthcare workers. DESIGN.  Observational survey involving HIV‐infected patients. Blood samples collected from source‐patients and potential source‐patients underwent HIV‐1 genotypic antiretroviral resistance testing and determination of CD4 counts and viral load. Affected healthcare workers were monitored for 6 months after exposure. SETTING.  The survey was conducted in a tertiary‐care hospital located in Sao Paulo, Brazil. Sao Paulo is considered the epicenter of the HIV–acquired immunodeficiency (AIDS) virus epidemic in Brazil. PARTICIPANTS.  Source‐patients, potential source‐patients, and affected healthcare workers. RESULTS.  A total of 371 occupational exposures to biological materials were reported, 46 (12.3%) of which were from HIV‐seropositive source‐patients. Samples from 18 source‐patients and 26 patients considered “potential sources for accidents” were analyzed. Of these 44 samples, 18 (41%) presented resistance‐related mutations in reverse transcriptase, protease, or both. Of these 18 samples, 16 (89%) had resistance to drugs included in the prophylactic schedule recommended by the Brazilian Ministry of Health. CONCLUSIONS.  Use of the Centers for Disease Control and Prevention–Brazilian post‐exposure prophylaxis regimen will result in the administration of antiretroviral agents to which the source HIV‐1 isolate will often be resistant. Therefore, it would be advisable to carefully investigate the history of use of antiretroviral agents by source‐patients and adjust the prophylactic therapy based on those data and, subsequently, the results of resistance testing.

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