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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

Published online by Cambridge University Press:  21 June 2016

Fabiane El-Far ,
Eduardo Alexandrino Servolo Medeiros ,
Carlos Teodoro Gasparoto  and
Ricardo Sobhie Diaz
Fabiane El-Far
Affiliation:
Instituto de Infectologia Emilio Ribas, Sao Paulo, Brazil Infection Control Hospital Epidemiology, Federal University of Sao Paulo, Sao Paulo, Brazil
Carlos Teodoro Gasparoto
Affiliation:
Laboratòrio de Retrovirologia, Paulista School of Medicine, Infectious Disease Division, Federal University of Sao Paulo, Sao Paulo, Brazil
Ricardo Sobhie Diaz*
Affiliation:
Laboratòrio de Retrovirologia, Paulista School of Medicine, Infectious Disease Division, Federal University of Sao Paulo, Sao Paulo, Brazil
*
Laboratòrio de Retrovirologia, Infectious Disease Division, Federal University of Sao Paulo, Rua Pedro de Toledo, 781 - 16° Andar. Vila dementino, Sao Paulo, SP, BrazilCEP: 04039-032. , rsdiaz@usp.br
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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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 9 , September 2005 , pp. 782 - 788
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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