Use of HIV Postexposure Prophylaxis in healthcare workers after occupational exposure: a Thai university hospital setting.

BACKGROUND: PostExposure Prophylaxis (PEP) is widely used after exposures to Human Immunodeficiency Virus (HIV) to reduce the risk of infection in the healthcare setting. Few data are available on the safety and tolerability of Anti Retro Viral drugs (ARV) among Health Care Workers (HCWs) who are prescribed prophylaxis. OBJECTIVE: To collect information about the safety and compliance of taking ARV for HIV PEP among HCWs. MATERIAL AND METHOD: Retrospective review on registry data regarding occupational HIV exposures, the PEP regimens used, and the adverse events associated with PEP was performed. RESULTS: During a five year-period, 820 episodes with occupational blood or body fluid exposures were reported Nurses (27%) were the largest group at risk. The most common type of exposure was percutaneous injuries (82%). Only 125 (15%) HCWs had occupational exposures to HIV, 64 HCWs were prescribed HIV PEP and 32 (50%) HCWs did not complete the PEP regimen as initially prescribed. The commonly prescribed ARV was zidovudine (38%), lamivudine (33%), and indinavir (11%). Overall, 18 (28%) HCWs reported symptoms while on PEP such as nausea (89%), vomiting (55%), and dizziness (39%). None of the HCWs had HIV seroconversion. CONCLUSIONS: Adverse effects from HIV PEP were very common. Clinicians prescribing HIV PEP need to discuss with HCWs about PEP efficacy and side effects. Education efforts aimed at occupational exposure prevention are still important issues.

Iron status of one-year-old infants in a well baby clinic.

Seventy-two healthy infants (37 males, 35 females) attending a private well baby clinic were enrolled in the study. Their mean birthweights and body weights at one year of age were 3,079 grams and 10 kilograms, respectively. Blood samples were drawn approximately on their first birthday for evaluating the iron status. Complete blood count, hemoglobin (Hb) typing and DNA analysis for common carrier status of thalassemia and hemoglobinopathis were also determined. According to the infants of serum ferritin, the patients were classified into 4 groups: group 1, iron deficiency anemia (Hb <11 g/dl and ferritin <12 ng/L) in 1 infants (1.4%); group 2, iron deficiency without anemia (Hb >11 g/dl and ferritin <12 ng/L) in 5 infants (6.9%); group 3, borderline iron depletion (ferritin 12-30 ng/L) in 39 infants (54.2%); group 4, iron sufficiency (ferritin >30 ng/L) in 27 infants (37.5%). The iron deficiency state emerged as 8.3 per cent (6/72). There was no significant difference of levels of Hb and mean corpuscular volume (MCV) among the infants with iron deficiency without anemia, borderline iron depletion and iron sufficiency. The results also revealed that 25 out of 72 (34.7%) infants were carriers of thalassemia and hemoglobinopathies. The carrier infants had significant lower Hb and MCV than those of the non-carrier infants with the p-values of 0.004 and 0.000, respectively; while their serum ferritin levels were not significantly different. Additionally, the association of carrier and iron deficiency state was further evaluated. The Hb and MCV among carrier infants with and without iron deficiency were not significantly different. Six infants with carrier state were found to have slightly decreased levels of Hb ranging from 10.3 to 10.9 g/dl with the ferritin ranging from 18.7 to 382.9 ng/L while the remainders had Hb of >11 g/dl. Therefore, 7 out of 72 (9.2%) infants had anemia (Hb <11 g/dl) which was caused by the carrier state of thalassemia and hemoglobinopathies (n=6) and iron deficiency anemia (n=1). The risk factors of iron deficiency status were associated with feeding regimen including continuation of breast feeding until one year of age without adequate haem iron supplement, exclusive formula feeding, inadequacy of solid food supplement with only one meal per day and excluding haem iron from animal liver without substitution. The infants with risk factors had significantly lower levels of serum ferritin (mean 14.1 +/- 1.7 ng/L) than those without risk factors (mean 31.9 +/- 1.9 ng/L) with a p-value of 0.000. In conclusion, adequate haem iron supplement in 3 meals of solid food is essential for the prevention of iron deficiency status in one-year-old infants.