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Biomedical subjects

V Puro

Publications and source records attributed to V Puro.

At least 73 records · Page 4Linked to original sources
PubMed1992

Zidovudine prophylaxis after accidental exposure to HIV: the Italian experience. The Italian Study Group on Occupational Risk of HIV Infection.

OBJECTIVES: To evaluate the use of zidovudine prophylaxis in HIV-exposed health-care workers (HCW) in Italy and to determine its short-term toxicity. DESIGN: Longitudinal, open study with retrospective and prospective collection of data. SETTING: All Italian clinical centres that care for HIV-infected patients and are licensed by the Ministry of Health to dispense zidovudine and 30 hospitals participating in the Italian Multicentre Study on Occupational Risk of HIV Infection. STUDY POPULATION: HCW and other individuals who accepted zidovudine prophylaxis after accidental exposure to HIV. RESULTS: Data were collected for 224 HIV-exposed individuals until 30 June 1991. An increase in zidovudine prophylaxis was observed. All but 10 subjects received 1000-1250 mg zidovudine per day. Anaemia (five cases), neutropenia (one case) and an increase in serum alanine aminotransferase levels (two cases) were the only haematochemical side-effects observed; none of the subjects ceased prophylaxis because of side-effects. More than 50% of subjects had constitutional reactions; as a result, prophylaxis was stopped by 29 patients. These adverse effects began within 10 days of prophylaxis; all resolved after prophylaxis was stopped. No HIV-antibody seroconversions were observed after a mean follow-up of 8 months. CONCLUSIONS: Zidovudine prophylaxis has become a feature of the management of occupational exposures to HIV in health-care settings; short-term toxicity is mild, dose-related and reversible. Further studies are needed to assess the risk of long-term sequelae.

Administration, Oral↗
PubMed1990

Occupational exposures to blood and risk of HIV transmission in a general hospital (1986-88).

We conducted a study on occupational exposure to blood in a 1500-bed General Hospital in order to define incidence, type and circumstance of each exposure and to assess the risk of HIV transmission. From 1986 to 1988 a total of 548 cases of accidental blood exposure were reported, with an average of 15 accidents/month. The health care workers exposed included 376 nurses (68.6%), 91 manual workers (16.6%), 54 surgeons (9.8%), 14 physicians (2.5%) and 13 laboratory technicians (2.4%). There were 206 (37.6%) incidents related to recapping of needles. Other types of needle-stick injuries accounted for 191 cases (34.8%), cuts with sharp objects for 110 (20%) and skin or mucous membrane exposure for 41 (7.5%). The highest incidence of exposure per month of work (in a total of 85,932 persons/month of work) and employment category was observed in nurses (.008) and the lowest in physicians (.001). Fifty-three (9.7%) employees were exposed to blood from patients with HIV infection: 36 nurses, 16 surgeons and 1 physician. No cases of seroconversion have been observed after a mean follow-up of 9 months (range: 2-18). The highest rate of HIV at-risk exposure per month of work was observed in surgeons (.001) and the lowest in physicians (.00008). Careful adherence to the universal infection-control guidelines published by international health authorities (W.H.O., C.D.C.) is recommended to prevent most at-risk incidents in health-care settings.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Monitoring HIV trends in injecting drug users: an Italian experience.

To examine the incidence and prevalence of HIV infection, we studied a large sample of intravenous drug users (IVDUs) attending a drug dependency unit in Rome over the period 1985-1989. The annual prevalence of HIV antibodies remained stable over the 5-year period. However, a seroconversion study conducted on 302 subjects consistently attending the same facility showed a continued occurrence of HIV seroconversion, although the incidence declined from 8.9 per 100 person-years in 1985-1987 to 5.3 per 100 person-years in 1987-1989. The cumulative incidence of HIV seropositivity, estimated by the Kaplan-Meier survival technique, was higher in female than in male IVDUs. The findings show that the use of both incidence and prevalence data to monitor the trend of HIV infection allows a better understanding of the current viral spread among IVDUs.

Adult↗
PubMed1990

Hepatitis C virus infection in intravenous drug users: prevalence and risk factors.

We investigated the relation of drug use and sexual behaviour to hepatitis C virus (HCV) infection among 80 intravenous drug users (IVDU) attending a methadone treatment program in Rome. Antibodies to HCV (anti-HCV) were found in 54/80 of IVDU (67.5%). Presence of anti-HCV was associated with duration of intravenous drug use and frequency of needle sharing (p less than 0.003 and p = 0.02, respectively, by chi-square for trend). No association was found between sexual behaviour and anti-HCV prevalence.

Adolescent↗
PubMed1989

[Piperacillin in the therapy of severe bacterial infections: comparison of its efficacy and tolerance vs. ceftazidime].

38 patients with severe acute bacterial systemic infections have been enrolled in this study: 19 patients were treated with piperacillin (100-200 mg/kg/day) and 19 with ceftazidime (45-90 mg/kg/day) by i.v. route. In both groups monotherapy has been found effective and well tolerated. Serious side-effects have not been observed. The high cure and eradication rates in both groups do not show statistically significant differences (chi 2 = 0.620 and chi 2 = 0.219, respectively, p greater than 0.05).

Adult↗
PubMedDate not supplied

Risk of human immunodeficiency virus infection for emergency department workers. Italian Study Group on Occupational Risk of HIV Infection.

To evaluate the risk of human immunodeficiency virus (HIV) exposure among emergency department workers (EDWs) and their ability to identify HIV-infected patients, a seroprevalence study was performed in March 1991 in the emergency departments (EDs) of six Italian urban hospitals. At each visit, patients aged 18-65 years were asked to undergo fingerstick blood sampling for anonymous, unlinked HIV testing performed on blood adsorbed filter paper collection cards. Demographic characteristics, known or suspected HIV risk factors, and occupational exposures reported by the EDWs during the patient's visit were recorded. On 9,457 consecutive visits, 9,005 samples (95%) were tested and 65 (0.7%) were HIV positive. ED staff failed to identify 59% of HIV-infected patients. The rate of occupational exposures was 0.13/100 visits. As it is impossible to predict the HIV status of patients attending EDs, adherence to universal precautions and the development of safer devices should be utilized to minimize the risk of blood-borne infections in EDWs.

Adolescent↗
PubMedDate not supplied

[Testing for HIV infection in pregnant women at the obstetric centers in Italy].

BACKGROUND: To assess antenatal HIV testing policy implemented in Italian obstetric centres. METHODS: Cross-sectional study, Site and Participants: Italian obstetric centres. INTERVENTION: structured postal questionnaire. Out-comes: policies and practices of antenatal HIV testing in Italian obstetric centres. RESULTS: A total of 213 centres, accounting for a total of 167.927 deliveries/year (30% of the Italian number of deliveries) filed out the questionnaire. Of these, 45% reported having a policy on HIV antenatal testing. Having a policy on antenatal testing is associated to the number of observed HIV-positive women. HIV testing is offered to all women in 89% of centres, included in routine antenatal tests in 67%, with an opt out (57.5%) or on opt in (10.5%) on request. HIV testing is performed at the initial clinic visit in 78% of centres; it is offered routinely to male partners in 7.5% of centres. Amongst centres which observed HIV-positive pregnant women, 47% reported zidovudine is not available as a measure of HIV vertical transmission prevention. CONCLUSIONS: In Italy, HIV testing seems to be routinely included in management of pregnancy, although the practices of offering the test seem not always appropriate and the availability of measures for reducing the risk of vertical transmission not adequate. Specific guidelines should be issued in order to implement and to uniform universal antenatal HIV testing, and to optimize the management of infected women.

Adolescent↗
PubMedDate not supplied

[The probability of transmission of the human immunodeficiency virus].

The probability of human immunodeficiency virus (HIV) transmission is one of the key epidemiological parameters in the spread of the AIDS epidemic. The understanding of its possible determinants is necessary for a thorough interpretation of epidemic dynamics and for the evaluation of alternative strategies to control the epidemic. We carried out a bibliographic review of the main studies reporting data on the probability of HIV transmission through sexual contacts and parenteral routes (by transfusion of blood and blood products, by occupational exposures among health care workers, by sharing needles among injecting drug users). Different values of probability are associated to different routes of transmission. The observed high variability depends on the viral load, on the biological fluid (blood or mucous secretions) through which the virus is transmitted and on several other factors related to source infectiousness and to individual susceptibility, both common to all routes of exposures and specific to each of them. It is currently too early to forecast how the introduction of highly active antiretroviral treatment, which strongly reduce the viral load in patients with HIV infection, will modify the probability of transmission. Therefore, the compliance with recommended preventive measures still represents an indispensable way to contrast the virus spread.

Female↗
PubMedDate not supplied

Monitoring the trend of the transmission rate of vertically acquired HIV infection: a simple method applied to Italian data.

The objective of this study was to develop and validate a method for estimating and monitoring over time the transmission rate of vertically acquired HIV infection at the population level. We estimated the annual number of children born to HIV-infected women in Italy in 1991-1994 by multiplying the seroprevalence rates, provided by Anonymous Unlinked HIV Serosurveys among Italian Newborns, by the annual number of births, provided by the Italian National Institute of Statistics. The number of HIV-infected children was estimated by applying a simplified back-calculation method to the incident cases of vertically acquired AIDS reported to the AIDS surveillance registry, using seven different estimates of the distribution of the incubation period identified through a literature search. The annual vertical transmission rates were estimated by dividing the estimated number of children with vertically acquired HIV infection by the estimated number of births to an HIV-infected mother. Depending on the chosen distribution of the incubation period, the estimated transmission rate for the four-year period ranges from 0.10 to 0.30. Five of the seven incubation distributions provided a rate falling within the very narrow interval 0.18-0.20. The method provided estimates of vertical transmission rates consistent with those of longitudinal studies performed in European countries. The method presented here could be useful for monitoring the impact of interventions aimed at reducing HIV vertical transmission rate.

Child, Preschool↗
PubMedDate not supplied

"Side" effects of HAART: decreasing and changing occupational exposure to HIV-infected patients.

To investigate percutaneous exposures to HIV in the highly active antiretroviral therapy (HAART) era, we performed an analysis of all percutaneous exposures reported from January 1994 to December 1998 in 18 Italian acute-care hospitals. Frequency and rate per 100 prevalent AIDS cases of HIV exposures decreased by 40% (from 4.3% to 2.6%, and from 1.0% to 0.6%, respectively; p<0.001), which were mainly those related to the insertion/manipulation of peripheral vascular access devices (from 7.2% to 4.8%; p=0.05). We conclude that the benefits of HAART have changed the complexity of care required and therefore, the number and type of procedures performed on HIV patients that place the HCW at risk of injury.

Antiretroviral Therapy, Highly Active↗