Antiretroviral drug resistance among patients with human immunodeficiency virus who act as sources or potential sources in occupational accidents involving healthcare workers.
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.
El-Far
Fabiane
F
Instituto de Infectologia Emilio Ribas, Sao Paulo, Brazil.
Medeiros
Eduardo Alexandrino Servolo
EA
Gasparoto
Carlos Teodoro
CT
Diaz
Ricardo Sobhie
RS
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
D019380:Anti-HIV Agents; D012367:RNA, Viral