title: Antiretroviral drug resistance among patients with human immunodeficiency virus who act as sources or potential sources in occupational accidents involving healthcare workers.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Instituto de Infectologia Emilio Ribas, Sao Paulo, Brazil.
authors.forename: Fabiane
authors.initials: F
authors.lastname: El-Far
authors.forename: Eduardo Alexandrino Servolo
authors.initials: EA
authors.lastname: Medeiros
authors.forename: Carlos Teodoro
authors.initials: CT
authors.lastname: Gasparoto
authors.forename: Ricardo Sobhie
authors.initials: RS
authors.lastname: Diaz
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D015497:HIV-1 / Q000235:genetics; D006282:Health Personnel; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D008297:Male; D016273:Occupational Exposure; D012367:RNA, Viral / Q000032:analysis
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral