Puro V, Calcagno G, Anselmo M, Benvenuti G, Trabattoni DS, Clerical MS, Ippolito G; National HIV Prevention Conference (1999 : Atlanta, Ga.).
Abstr Search Tools 1999 Natl HIV Prev Conf Natl HIV Prev Conf 1999 Atlanta Ga. 1999 Aug 29-Sep 1; (abstract no. 518).
IRCCS L. Spallanzani-via Portuense 292, Rome, Italy. Fax: (39) 065594224. E-mail: craids@excallhq.it.
BACKGROUND: Rational application of diagnostic assays in the management of health care workers (HCW) reported with occupational exposure to HIV is required. The use of highly sensitive biomolecular assays is tentative in order to achieve the earliest possible diagnosis. Quantitative plasma viral load testing have become familiar in clinical settings, because of routine use in HIV-infected patients. However, misdiagnosis of HIV infection by these tests has been described (Schwartz, Lancet 1997 350 256-8; Rich, Ann Intern Med 1999; 130: 37-9). We report a case in which a further explanation arises for a transient detection of plasma HIV-1 RNA copies after an occupational exposure to HIV n an uninfected HCW who was treated with combination PEP. CASE REPORT: A HCW suffered a deep needle-stick injury to the right medium finger while removing the stylet after the insertion of a vascular catheter in an AIDS patient (disseminated mycobacteriosis, 25 CD4/mmc, and 270.000 HIV- RNA cp/ml by NASBA) who had never been treated with antiretroviral drugs. The HCW within 1.30 h of the exposure began taking zidovudin 500/mg, lamivudine 300/mg, and saquinavir 1,800/mg daily. At baseline, the HCW tested HIV-+ negative by EIA. Two weeks after the exposure, while on treatment, the HCW underwent a plasma viral load test (Nuclisens, Organon) for HIV-1 RNA that yielded a positive value of 20,000 copies/ml. A second sample drawn after additional 4 days was positive at 1,800 cp/ml. The HCW did not complain about any symptom. AZT was substituted with d4t 40 mg bid. One month from the exposure the HCW was HIV negative by EIA and Wb; HIV RNA was <40 cp/ml; PEP was stopped. Serologic tests were negative after 3, 6 and 12 months from the exposure; HIV RNA was undetectable (<40 cp/ml) at 12 months. At 13 months the HCW exhibited a significant HIV-specific T-helper response assessed by IL-2 production to T1, T2, MN, and HP23 antigenic peptides from the envelope of HIV (25 mM) and to a pool of these HIV peptides, according to the protocol previously described that this individual has at least been transiently infected (Clerici JAMA 1994; 271: 42-6), suggesting. CONCLUSION: A cautious use of biomolecular assays is recommended in the management of HCW reporting an occupational exposure to HIV. Indeed, the potential sequelae of a diagnosis of HIV infection based on a false positive result should be taken into account. Moreover, a transient detection of plasma HIV- 1 RNA could be due to abortive infection, raising additional questions. Further data are needed to guide the management of similar cases.
Publication Types:
Keywords:
- AIDS Vaccines
- Acquired Immunodeficiency Syndrome
- Communicable Diseases
- HIV Infections
- HIV Seropositivity
- Health Personnel
- Humans
- Needlestick Injuries
- Occupational Exposure
- Transients and Migrants
- Viral Load
- Zidovudine
Other ID:
UI: 102187711
From Meeting Abstracts