Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

XIV International AIDS Conference

Abstracts WePeC6140-WePeC6143 117

were tested for HIV, HBV, and HCV in a blinded fashion. Logistic regression was
done to evaluate risk correlates. To determine intra-prison incidence, inmates with
a prevalence sample, continuously incarcerated for at least 11 months without release, were approached for a second testing. Serial samples were tested and
incidence was calculated using person-years (PY).
Results: At intake, prevalence for HIV was 1.5%, for HBV was 20.6%, and for
HCV was 25.9%. While males were more likely to be HIV positive than females
(1.65% vs. 0.48%, respectively), females compared to males were more likely to
be HBV positive (40.73% vs. 23.8%) and HCV positive (32.2% and 19.0%) at
intake. HIV prevalence was associated with black and Hispanic race, and age.
Being HIV, HBV, or HCV seropositive was significantly associated with being infected with either of the other two infections. For intraprison incidence, 281 consented and had test results. No inmates seroconverted to HIV with 437.5 PY
follow-up. Twelve inmates seroconverted to HBV (3.3/100 PY), while for HCV, 2
seroconverted (0.59/100 PY). Only one seroconverter (HBV) was female and all
seroconverters were HIV seronegative.
Conclusions: Despite low HIV prevalence at prison intake, the prevalence of
hepatitis B and C is high. While no intraprison transmission of HIV was found,
intraprison incidence of HBV and HCV among HIV seronegative inmates signifies high risk behaviors are occurring. Prisons represent a unique public health
opportunity for prevention of HIV and other infections.
Presenting author: Grace Macalino, 169 Angell St., Box GS-210, Providence,
RI, 2912, United States, Tel.: [phone], Fax: [phone], E-mail:
Grace [email protected]
WePeC6140 Implementation of a multidisciplinary program to
manage occupational exposure to blood and body
fluids at a secondary care hospital in Brazil
A.M. Oliveira', J.B. Freire1, M.F Schneider', A.M.S. Correa2, F.H. Aoki2
IHospital Estadual Sumare, Nucleo de Saude Publica, Hospital Estadual
Sumare, Avenida da Amizade, 2400, 13170-000 - Sumare - SP, Brazil;
2 Universidade Estadual de Campinas, Unicamp, Campinas, Brazil
Background: Occupational exposure to blood can lead to transmission of HIV,
Hepatitis B virus (HBV), and Hepatitis C virus (HCV) in the health care setting. In
order to provide easy and rapid access to Post Exposure Prophylaxis (PEP), we
organized a multidisciplinary approach to guarantee health care workers (HCW)
a 24h access to medical evaluation in Hospital Estadual Sumare, State University
of Campinas, Brazil.
Methods: The system was established in April 2001. Our primary concern was to
provide immediate attention to HCW exposed to blood. The laboratory performs
baseline tests (HIV, HBV, HCV) in the HCW and the source patient, and rapid
detection test for HIV in the source patient. Counseling and immediate medical
attention is provided by the emergence room staff who were trained to introduce
PEP in accordance to the CDC guidelines. The pharmacy provides Hepatitis B
vaccine and medicines. An infectologist is responsible for the 6-month follow-up.
Data related to the exposures are periodically reviewed and guide the implementation of preventive strategies.
Results: From April to December 2001, 36 exposures occurred at the hospital.
They occurred in nurses (61%), physicians (22%), maintenance staff (11%), and
physical therapists (6%). 84% of them were percutaneous injuries, 16% mucous
membrane contact. Source patients were not identified in 22% of cases. Most
often exposures happened in inpatient wards and operating unit (39% each), followed by ICU (17%). Personal protective equipment was not correctly worn in
19% of cases. 28% of HCW exposed did not have a complete course of Hepatitis
B vaccine. PEP for HIV was innitiated in 2 HCW with good adherence and no
seroconversion was observed.
Conclusions: The multisdisciplinary approach was crucial to the succes of this
program and periodical training is necessary to reduce high-risk behavior. Data
available from surveillance permit the implementation of strategies to offer both
patients and HCW a safer workplace.
Presenting author: Alexandre Oliveira, Nucleo de Saude Publica, Hospital Estadual Sumare, Avenida da Amizade, 2400, 13170-000 - Sumare - SP, Brazil, Tel.:
[phone] ext. 1161, Fax: [phone] ext. 1165, E-mail: alemacedo
@ uol.com.br
WePeC6141 Surveillance of post-exposure prophylaxis for
occupational exposures to HIV in health care
workers in France
F Lot, 0. Larsen, B. Basselier, A. Laporte. Institut de Veille Sanitaire,Fnstitut de
Veille Sanitaire, 12, rue du Val d'Osne, 94415 Saint-Maurice cedex, France
Background: Since 1995, the French Ministry of Health has recommended using antiretroviral drugs as post-exposure prophylaxis (PEP) following occupational
exposures to HIV in health care workers (HCW). In 1998, non-occupational exposures to HIV were included in these guidelines and use of a 3-drug regimen

was recommended. A hospital sentinel surveillance was set up in July 1999. The
objectives are to monitor the characteristics of HCW seeking advice for PEP, the
use and toxicity of PEP and the follow-up testing in the 6 months after exposure.
Methods: The standardised forms (inclusion, 1- and 6-month follow-up) were
sent to all participating hospitals. HCW presenting in the first week after exposure to HIV were included after consent (HIV status of the source may be positive
or unknown).

Results: By June 2001, 2898 HCW (nurses: 42%; physicians: 15%; nurses' assistants: 12%; housekeepers: 10%; laboratory staff: 6%) had sought advice for
PEP after percutaneous injury (82%) or mucocutaneous contact (18%) with a
body fluid from a proven (25%) or unknown (75%) HIV-infected patient, in 69% of
cases within 4 hours of exposure. PEP was prescribed for 31% of HCW: usually 3
drugs (78%) including protease inhibitor (68%) or 2 drugs (17%). The proportion
of treated HCW varied widely by type of exposure: from 95% following a deep
puncture with a needle used in vein or artery in an HIV(+) patient to 10% following a superficial injury with a solid needle in an unknown source. Among treated
HCW, 41% were followed up at 1 month: PEP was completed in 87%. Adverse
symptoms were observed in 77% and biological abnormalities in 12%. Serological follow-up is available for 25% of HCW: no seroconversion was reported.
Conclusion: PEP prescription in HCW is generally in line with the official recommendations. Nevertheless, the potential toxicity of PEP must be carefully considered especially for exposures with low risk of HIV transmission.
Presenting author: Florence Lot, Institut de Veille Sanitaire, 12, rue du Val
d'Osne, 94415 Saint-Maurice cedex, France, Tel.: [phone], Fax:
+33.(0)1.41.79.67.66, E-mail: [email protected]
WePeC6142I The Italian registry of antiretroviral post-exposure
prophylaxis
G. De Carli, V. Puro, S. Cicalini, F Mattioli, Z. Lazarevic, G. Ippolito on behalf of
IRAPEP. INMI Spallanzani, Department of Epidemiology, INMI Spallanzani, Via
Portuense 292, 00149, Italy
Background: HIV post-exposure prophylaxis (PEP) is recommended for occupational exposure and considered after nonoccupational exposure to HIV.
Methods: To monitor PEP, a National Registry was instituted by the Italian Ministry of Health.
Results: From Jan 1997 to Dec 2001, 903 (67%) occupational exposures in
healthcare workers (HCW), and 264 (23%) non HCW exposures were collected;
drop-outs were 2% and 4.5%, respectively. No seroconversions were reported.
HCW exposures were 548 needlesticks, 87 cuts, 240 mucocutaneous contaminations, and 43 others/unavailable. HCW acceptance increased from 35% in
1997 to 52% in 2001. Initial regimens included 2 NRTI (gr.A) in 394 cases, (366
ZDV+3TC), plus 1 protease inhibitor (PI) (gr.B) in 482 cases (ZDV+3TC+IDVin
432). Nevirapine was rarely used. 223 HCW interrupted PEP when the source
tested negative, after a mean of 3d, median 2, range 1-13; of these, 8% developed side effects. For non-HCW (102 cases in gr.A and 147 in gr.B), 66 were
occupational exposures occurring outside the healthcare setting and 198 other
exposures (of which, 4 needlesharings, and 80 sexual exposures). Mean time of
starting PEP was 4.40h, 16h and 5.5h among HCW, sexual and other exposures.
Mean PEP duration was 16d for HCW (median
8, range 1-60) and 24d for non HCW (29, 1-46); 37% HCW and 61% non HCW
completed the 4-week regimen. Overall, 27% of gr.A and 41% of gr.B reported at
least one mild and reversible side effect, mostly gastrointestinal (60%). 14% HCW
and 11% non HCW interrupted PEP because of side effects. Renal colic occurred
in 7 cases, decreased Hb (11), and increased bilirubin (23) and AST levels (14),
were all observed in gr.B.
Conclusion: We observed an increasing use of occupational and of not formally approved non occupational PEP, and of PI containing regimens as an initial
regimen. Efforts should be made to ensure a rapid assessment of the source's
serostatus in order to limit unnecessary PEP and its related toxicity and costs.
Presenting author: Gabriella De Carli, Department of Epidemiology, INMI Spallanzani, Via Portuense 292, 149, Italy, Tel.: [phone], Fax: +39 06
5582825, E-mail: [email protected]
WePeC6143 Surveillance of post-exposure prophylaxis for
non-occupational exposures to HIV in France
C. Larsen, F Lot, B. Basselier, A. Laporte. Institut de Veil/e Sanitaire, Institut de
Veille Sanitaire, 12, rue du Val d'Osne, 94415 Saint-Maurice cedex, France
Background: In 1998, French recommendations for post-exposure prophylaxis
(PEP) in occupational exposures were extended to include non-occupational exposures: sexual (SE), injecting-drug-use (IDU) and other non-occupational (OE)
(e.g. injuries with discarded syringe, human bites). Use of a 3-drug combination
was recommended. A hospital sentinel surveillance was set up in July 1999. The
objectives are to monitor the characteristics of persons seeking advice for PEP,
the use and toxicity of PEP and the follow-up testing in the first 6 months after
exposure.
Methods: The standardised forms (inclusion, 1- and 6-month follow-up) were
sent to all participating hospitals. Persons presenting in the first week after nonoccupational exposure to HIV were included after consent (HIV status of the
source patient may be positive or unknown).
Results: By June 2001, 4024 persons had sought advice for PEP: 74% after SE,
1% after IDU and 25% after OE. The median presentation time was 17h after SE,

22h after IDU and 4h after OE. The source was known to be HIV(+) in 21% of
cases: 24% after SE, 43% after IDU, 13% after OE. PEP was prescribed for 73%
of exposures: 82% after SE (from 89% after anal receptive to 65% after oral sex),
90% after IDU and 46% after OE. PEP used was generally a 3-drug (82%) or a
2-drug (14%) combination. Overall, 42% of treated persons were followed-up at 1
month: PEP was completed in 86%. Adverse symptoms were observed in 67%:
45% for the 2-drug and 70% for the 3-drug regimen. Biological abnormalities were