Efeitos adversos da profilaxia antirretroviral após exposição ocupacional ao HIV / Adverse effects of antiretroviral prophylaxis after occupational exposure to HIV

A exposição ocupacional a material biológico com risco de transmissão do vírus da imunodeficiência humana (HIV) constitui uma emergência médica. A profilaxia pós-exposição (PEP) deve ser iniciada precocemente e mantida por 28 dias. Desde julho de 2015, o Ministério da Saúde passou a recomendar o uso combinado de três drogas antirretrovirais para a PEP, menos tóxicas e melhor toleradas do que as usadas anteriormente. Apesar disso, quase metade dos expostos em uso da PEP apresenta efeitos adversos. Geralmente, eles são leves e autolimitados. Os mais comuns são alterações gastrointestinais, astenia, cefaleia e tontura. Entretanto, eventos mais graves já foram observados e a taxa de interrupção da profilaxia permanece elevada. Em 2017, o Ministério da Saúde modificou o esquema de primeira linha da PEP, substituindo o terceiro antirretroviral. Esse artigo relata um caso de toxicidade associada ao uso da PEP após exposição ocupacional a material biológico contaminado pelo HIV, traz a revisão dos potenciais efeitos adversos das drogas antirretrovirais que compõem o esquema profilático preconizado pelo Ministério da Saúde e discute a conduta do médico do trabalho diante dessas complicações.

Occupational exposure to biological materials involving risk of human immunodeficiency virus (HIV) transmission is a medical emergency. Post-exposure prophylaxis (PEP) should be started early and administered for 28 days. Since July 2015, the Brazilian Ministry of Health recommends the combined use of three antiretroviral drugs for PEP, which are less toxic and better tolerated than the ones previously used. Nevertheless, almost half of the exposed individuals under PEP exhibit adverse effects, which are usually mild and self-limited. The most frequent adverse events are gastrointestinal disorders, asthenia, headache and dizziness. However, more severe events have been reported, and the rate of non-completion of prophylaxis remains high. In 2017, the Brazilian Ministry of Health modified the first-line PEP regimen involving replacement of the third antiretroviral drug. The present article reports a case of toxicity associated with PEP following an occupational accident involving exposure to HIV infected biological material. In addition, we review the potential adverse effects of antiretroviral drugs included in the prophylactic regimens recommended by the Brazilian Ministry of Health and discuss measures occupational physicians should adopt vis-à-vis these complications

Standard operating procedure: implementation, critical analysis, and validation in the Audiology Department at CESTEH/Fiocruz

ABSTRACT Purpose Evaluate three standard operational procedures (SOPs), regarding the application of the brainstem auditory evoked potential (BAEP) test, implemented by the Audiology Department of the Center for Studies in Occupational Health and Human Ecology (CESTEH) through the application of a questionnaire and to verify whether the SOPs are effective and assess the necessity for improvement. Methods The study was conducted in three phases: in the first phase, eight speech-language pathologists and seven physicians, with no experience in BAEP, were instructed to read and perform each SOP, eventually all individuals evaluated the SOPs by responding to a questionnaire; in the second phase, the questionnaires were analyzed and the three SOP texts were reviewed; in the third phase, nine speech-language pathologists and six physicians, also with no experience in BAEP, read and re-evaluated the reviewed SOPs through a questionnaire. Results In the first phase, difficulties in understanding the texts were found, raising doubts about the procedures; however, every participant was able to perform the procedure as a whole. In the third phase, after the review, all individuals were able to perform the procedures appropriately and continuously without any doubts. Conclusion The assessment of the SOPs by questionnaires showed the need for adaptation in the texts. After the texts were reviewed according to the suggestions of the health professionals, it was possible to observe that the SOPs assisted in the execution of the task, which was conducted without any difficulties or doubts, being regarded effective and ensuring quality to the service offered.