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Retroviruses have a single-stranded RNA genome that undergoes a special form of replication. Once the retrovirus has entered the host cell, an enzyme called reverse transcriptase synthesizes double-stranded DNA from the retroviral RNA genome. This DNA copy of the genome is then integrated into the host’s genome inside the nucleus via an enzyme called integrase. Consequently, the retroviral genome is transcribed into RNA whenever the host’s genome is transcribed, allowing the...
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Transmission-based precautions are for patients infected or suspected to be infected (or colonized) with organisms posing a significant risk to others. The transmission precautions include airborne and protective environment precautions.
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An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
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Prophylaxis for occupational exposure to HIV

J L Gerberding1

  • 1San Francisco General Hospital, California, USA.

Annals of Internal Medicine
|September 15, 1996
PubMed
Summary

Post-exposure prophylaxis with zidovudine (AZT) significantly reduces the risk of human immunodeficiency virus (HIV) infection after occupational exposure. This treatment is recommended for healthcare workers at risk, with specific regimens for high-risk exposures.

Area of Science:

  • Infectious Diseases
  • Virology
  • Occupational Health

Background:

  • Healthcare providers face risks of human immunodeficiency virus (HIV) exposure through percutaneous injuries.
  • The average risk of HIV transmission from needlestick injuries is approximately 0.3%, but can be higher with certain exposures.
  • Indirect evidence suggests antiretroviral chemoprophylaxis may prevent HIV infection after exposure.

Purpose of the Study:

  • To evaluate the efficacy of post-exposure prophylaxis (PEP) in preventing HIV infection among healthcare providers.
  • To review current recommendations for PEP regimens following occupational HIV exposure.

Main Methods:

  • Review of indirect evidence, including studies on zidovudine (AZT) efficacy in preventing perinatal transmission and treating acute retroviral infection.

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  • Analysis of case reports of "aborted" HIV infections in healthcare workers following contaminated needle sticks.
  • Examination of current guidelines for PEP, including drug combinations and duration of treatment.

    • Main Results:

    • Treatment with zidovudine after percutaneous exposure may reduce the odds of HIV infection by nearly 80%.
    • Zidovudine prophylaxis is effective in preventing perinatal HIV transmission.
    • Antiretroviral treatment during the window of opportunity after exposure may prevent viral propagation.

    Conclusions:

    • Post-exposure prophylaxis with antiretrovirals, particularly zidovudine, is supported by indirect evidence for preventing occupational HIV infection.
    • Current recommendations favor a 4-week regimen of zidovudine plus lamivudine.
    • Protease inhibitors like indinavir are recommended for high-risk exposures or when the source patient may have resistant HIV strains.