Abstracts Vol. 1 [International Conference on AIDS (11th: 1996: Vancouver, Canada)]

Tuesday, July 9, 1996

Tu.C. 122 - Tu.C.200

Tu.C.122
HIGH DOSE ZIDOVUDINE POST EXPOSURE PROPHYLAXIS IN
42 HEALTH CARE WORKERS
C. Michelet, F. Besniet C. Arvieux, C. Camus, F. Cartier. Departmentr' i netiousi diseases,
University of Rennes, France
Objectives: To propose a Guideline for the use of post-exposure pr YI x s.'ith AZT in
health care workers (HCW) after contact with contaminated bo, r I s Ilr I lV infected
patients, and to evaluate its efficacy and toxicity.
Methods: Prophylactic ZDV therapy after occupational exposure i i ' qsestions.
Failures of ZDV therapy with the recommended dose of I1200 r p2 d, h, been
reported, and half of HCW who start prophylaxis stop it before the en of' the,, weeks
prescription, often in relation to side effects. Since 1989, we prop.),e i 5 1A 500 mg
qid ZDV therapy for 8 days, started as soon as possible after exp,:. re c sinomn ended
time: 15 min). After a 24/24 h phone advice, therapy is initiated if th, ' re,Io contaminated body fluids of a known HIV infected patient is assessed. In i,-f,.inii, hours, clinical and biological examination is performed. HCW are followed:,)I.
Results: Clinical, biologic and psychologic evaluation were analyzed, I 2 1 Cs swho
accepted to participate to the trial after informed consent. ZDV w, ta: wit in one hour
after exposure in 49%, and within 3 hours in 74%. Reported side cflets w r n ausea
(6 1%), asthenia (49%), vomiting (I 5%), abdominal pain (I 5%), myal i 2%), phalalgia
(1 2%), anemia, defined as a hemoglobin decrease over I g/dl (12%) ind uid neuitropenia
(8%). An 8 day completion of treatment was assessed in 90% of IIC_ lv e tIiercent had to
stop ZDV therapy in relation to side effects.The dose was reduced i 5% t)r t, ec same reason. No HIV seroconversion was observed during follow up.The psychioagc rnpact of
treatment was considered as good in 38% of HCW, but 27% dcli 'ed i ease of anxiety in relation to the drug and the 4 doses per day schedule; 35% c.trsdr nimpact on
their way of life, and 87% were ready to take a new post-exposue r, Ixs irnecessary
Conclusion: With respect to biological examination (Hb) at day,ri an; ee in the
number of patients included in this study we concluded that the A7 i00 mo cqd 8 days
regimen can be proposed to HCW, as soon as possible after expose r5 tIl,
C. Michelet, Dep. des Maladies Infectieuses-Ponchaillou, 35033 renne, Fr nce
Tel: [phone] Fax: [phone] I 88
Tu.C.123
RISK OF OCCUPATIONAL HIV AND HCV INFECTION AFTER OCCUPATIONAL
EXPOSURE
Ippolito Giuseppe, De Carli G, Pure V Petrosillo N and the Studio Ita!is1 s R hio
Occupazionale da HIV (SIROH)* group Coordinating center: Centro di Rifnrmento AIDS -
Spallanzani Hosp.- Rome, Italy
Objective: To estimate the risk of infection following an occupationl expoe,,,: (E) to HIV
and HCV for health care workers (HCWs).
Methods: Details of HIV OE were collected since 1/86 from mor e thian 30 hospitals; in
4/90 zidovudine (ZDV) prophylaxis was started, and since 1/92 detail of I Ii OE were
collected. HCWs were followed clinically and serologically up to at rea 6 r"ionths.
Results: As of I 2/95, 2447 HIV OE had been collected, and in 338 c,t, the source
patient (SP) was also HCV-infected.Three cases of occupational H IV iI tion with documented seroconversion (SC) occurred following a percutaneou (t (3/1637=0.18%;
95% C.I. 0.04-0.53), 2 of which after hollow bore needlestick injru -ch1066=0. 19%; 95%
C.I. 0.02-0.67) and one after a scalpel injury (1/351 injuries with sil, sharps= 0 28%; 95%
C.I. 0.01-I.58). One case occurred after a mucous contamination (MC) (/34-4=-0.29%;
95% C.I. 0.0 I- 1.61), who acquired also nAnB hepatitis; no SC ca-,', wc,ed after nonintact skin contamination (0/466; upper confidence limit 0.79%). 3 58 H consented to
ZDV postexposure prophylaxis. One of the PC and the MC SC oc rird Ibefore ZDV
prophylaxis protocol was issued; the remaining two PC SC cases decined ZDV offer; no
SC occurred after ZDV prophylaxis. Eight HCV SC (5 of which hsd acute C hepatitis)
occurred after hollow-bore needlestick injury (8/987=0.81I%; 95% C I. 0. 135-.9); in 3 SC,
the SP was coinfected with HIV (3/I 83= I1.63%; 95% C.I. 0.33-4.6 no HCV C occurred
following other ways of exposure.
Conclusions: These data confirm previous findings regarding the ris. of a quirin, bloodborne infections associated with hollow-bore needlestick injurie, depending on the efficacy
of transmission of the bloodborne agent which seems higher for H-CV tis for HIV, expecially when the SP is coinfected with both agents. Nevertheless aI r is ia posed by solid
sharps injuries and mucous contaminations, while the efficay of. C /n rVipsceting HIV
transmission is still to be defined.
* Angarano GAric C, Baccaro C, Battistella L, Bertucci R, Bianci,- 5I fir, B srn,;;,ate M,
Bonaventura ME, Bottura P Cestrone A, Chiodera A, Chirraco' P iPirte iicorno P Corradi
MP Cristini G, Daglio M, DAnna C, De Gennaro M, Desperati -, I3 ieardo L, Di Nardo
V, Finzi G, Francavilla E, Francesconi M, Giamperoli A, laneselli F, LodI A. iubr.1,a G,
Maccarrone S, Maggi P Marchegiano P Menichetti F, MercurioV,. ilin R Psont A, Nativi A,
Nelli M, Orazi D, Orefice E, Pema MC, Pietrobon F, Pischedda L, Pi azzini c-1, Pori C, Raineri
G, Ranchino M, Raponi G, Rebora M, Salvi A, ScappiniP Segata A, Srrcino fI, StIeo C,
Sommella L, Suter F, Testini B,Trarna C,Vaglra AVarra LM,Vlaces 1).
C. Ippolito, Centre di Riferimento AIDS-Dsp. L. Spallanzarnr Via PF; Is r, 2.-. 2 ) I 0049
Rome - Italy Phone [phone] Fax [phone] a S p -o Iy Italian
Ministry Health - ISS 9301.05
Tu.C.124
FREQUENCY AND PERCEIVED RISK FOR BLOOD EXPOSURE AMONG MEDICAL
STUDENTS. RESULTS OF A SURVEY STUDY.
Tarantola Arnaud*, Casalino * Gadjos Vt, Fleury L*", CoutelI B wet E s.
*Bichat-Claude Bernard and a*Pitid-Salpetriere University Hospit r. Paris, France
Objective:To evaluate the fiequency and perceived risk of blood ir n
pathogens exposure among medical students in a Paris teaching
Method:We carried out a questionnaire survey amon the ent,.. u -n population of two major teaching hospitals during their semestrial rott, ieIon.
Analysis was carried out using Epi Info 5.1. Odds ratio and Chi,, a,l' were performed when needed.

Results:'Ve collected a total of 466 questionnaires. Previous blood exposure was reported
by 3.7% o f medical students (first year medical students: 5.5%; second-year: 17.8%; thirdyear: 48% fourth -year: 45.6%; p<0.0001)Two-hundred and fifty (55%) of these students
never recapped needles after use and 200 (45.9%) always used a needle disposal box, while
136 (29.2%) did both. Amongst those who used both precautions, only 30 (22%) reported
blood exposre n(significant difference, p<0.000 I). Index patients were known to be infected
with HIV in 5% of cases. Most students (305 students, 66%) accurately perceived the risk
of transmission following accidental exposure. Students who had prior blood exposure
were is willing to continue to care for people with HIV as students who had not been
exposed (73% versus 71.7%; ns). Of the students who declared prior blood exposure, only
38% comnpleted the voluntary notification procedures and 34% resorted to occupational
medicirne folow-up.
Conclusion: Medical students are at a high risk of occupational exposure to HIV and other
blood borne pathogens. Observance of universal precautions is known to significantly
reduce th i risk. Specific training in occupational safety focusing on practical skills should be
s cessible to medical students, and should be reinforced on a daily basis. As medical students are fIequently exposed, hospitals should have a wellestablished and wellknown pro
cedure i Ideal with such accidents (including notification, counseling, prophylaxis if desired
and follow eu).
Casaiino/:idres Enrique, 46 Rue A. Huchard 75877 Paris Cedex 18-France,
Fax: 33 I 0 5 5 8829.Tel: 33 I 40 25 8080
Tu.C.125
EXAMINATION ON DENTAL CHAIR UNITS FOR BLOOD CONTAMINATION
Yoshitsuge Tera uchi. Sagami Dental Clinic, Kanagawa, Japan; Tokyo Medical and Dental
University Isepartment of Oral Surgery,Tokyo, apan
Objectives: To detect blood contamination on dental chair units using luminol test, find out
what part is the dirtiest, and discuss the results for HIV prevention.
Methods: sixteen dental chair units were examined ramdomly on the floor of the
Department of Endodontics at Tokyo Medical and Dental University Tokyo, Japan. Five parts
( instrumenti holder, work table, switch panel, light handle, spitoon) of each unit were
checked by spliashing luminol solution over them (Luminol solution is activated by blood,
especiall old blood and becomes luminous).The number of the parts that responded to
lur col solution was counted and calculated as a rate of percent.The dirtiest part contaminated by blood w,'as shown and discussed.
Results: Instrurrrent holder is the most contaminated a shown below. Light handle is the
cleanest of the five.

Ex irined parts
Instr ument holder
Work Itable
Switch panel
Spltoon
_Icht handle

Number of the parts responded
16
6
12

Percent (%)
100
37.5
75
87.5
25

N
L.
a)
0
u
C
to
c0
a)
C3
a)
0
U
0
C
a)
C
240

Conclusions: Instrument holder was turned out to be the dirtiest part on the dental chair
unit. Due to the complicated shape of the part, the difficulity in cleaning, and the frequent
exposure to blood and saliva, it can easily be contaminated by blood. Switch panel has the
same reason as its shape makes it difficult to clean and we often touch it with the fingers
that go into a patient's oral cavityTherefore it could be said that complicated shapes would
make it both easier to get contaminated and more difficult to clean up.We suggest that in
order to prevent HIV infection they should be modified to as simple shapes as possible or
some disposable protector should be made to cover each part that could be contaminated.
Firauch oshitsugu, 3-3-2, Chuo-rinkan,Yarmatc-shi, Kanagawa-ken, 242 Japan.
Tel: [phone] I; Fax: [phone] I I; email: [email protected]
Tu.C.200
RESULTS OF UNLINKED ANONYMOUS HIV PREVALENCE MONITORING OF
PREGNANT WOMEN, STD PATIENTS AND INJECTING DRUG USERS IN SLOVENIA
Klavs Irena* Kr stancic L*, Celan Lucu B*t, Krek J"", Krek M5t, Kastelic Z*, Poljak
M*, Piskir Kosmac D.*. * Institute of Public Health, Ljubljana, Slovenia;*
Microbiology Institute, Medical Faculty Ljubljana, Slovenia;** Primary Health Care Centre,
Liubtiana, Smovenia****Ilnstitute of Publc Health, Kope, Slovenia;*****Ministry of Health,
Ijubljana, Slovena
Objectives: VVe monitor the prevalence of HIV infection in accessible groups at higher risk
for HIV inlection (patients with sexually transmitted diseases (STDs) and injecting drug
users) and it loer risk (pregnant women) more representative for general population.
Methods: Since i993 unlinked anonymous HIV seroprevalence surveys of pregnant women
and S TD patients are conducted in several regions of Slovenia. Residual sera from sera sampies sent for syphilis serology are consecutively sampled in syphilis serology laboratories.
Since 1995 saliva samples are voluntarily obtained from all injecting drug users who are
enterin imethadone maintenance programme in two regions. Sampling period is one year,
except for sera of pregnant women in two regions, where sufficient numbers are collected
by mid of each year: A millilitre of the residue of each eligible serum and saliva sample
obtained with Omni Sal collecting system are placed in a container, labelled with sex and
age group, frozern and stored at -20 C. At the end of the sampling period samples are
Ie ted for.htibodies to HIV I and HIV 2.
Results: Of the sera collected in 1993, none tested positive of 9875 pregnant women sera,
a1d 2 te,.ed positive of I 183 STD patients' sera ( 1,7 per 1000). Of the sera collected in
1994, none tCted positive of 6468 pregnant women' sera, and none tested positive of 860
S Tr ptents' sera.T he results of testing sera (pregnant women, STD patients) and saliva
samples (intciing drug users) collected in 1995 wil ilso be presented.
Conclusions: HIV prevalence in low risk heterosexual population in Slovenia is still very
iw in ig,,, tisk population, such as STD patients, we can expect some HIV infections,
however he prevalence is low./ith monitoring changes in HIV prevalence by repeating
the sul vic,in sentinel populations, we can infer about the distnrbutionr and spread of HIV