Prevalence of abnormal adrenocortical function in human immunodeficiency virus infection by low-dose cosyntropin test.

Recent evidence suggests that 10 microg cosyntropin test has higher sensitivity for detecting hypothalamus-hypophysis-adrenal axis (HHA-A) dysfunction. Our objective was to determine prevalence of glucocorticoid insufficiency with the 10 microg cosyntropin test and the level of the HHA-A defect. One hundred and four HIV-infected patients underwent the 10 microg cosyntropin test. In abnormal and borderline respondents, insulin-induced hypoglycaemia test and human corticotropin releasing hormone test were used to confirm and localize the level of the HHA-A defect. Thirty-two patients with HIV infection and 72 with AIDS were identified. Prevalence of glucocorticoid insufficiency by the 10 microg cosyntropin test was 21.2%. By clinical categories, the frequency in AIDS and HIV infection patients was 26.4% and 9.4%, respectively. Confirmed glucocorticoid insufficiency by insulin-induced hypoglycaemia test was found in 16 out of 19 cases. Twelve cases had primary glucocorticoid insufficiency, 7 had secondary glucocorticoid insufficiency and 3 were false positive. In conclusion, adrenocortical dysfunction occurs in approximately 20% of the cases with HIV disease. Clinical findings commonly occurring in HIV disease as well as adrenocortical insufficiency are not reliable indicators for performing adrenocortical laboratory assessment. Our results suggest screening all AIDS patients with the 10 microg cosyntropin test.

[Occupational accidents and incidence of HIV infection and hepatitis B and C at a Mexican institution]. / Accidentes laborales e incidencia de infección por VIH y hepatitis B y C en una institución mexicana.

INTRODUCTION: The risk of developing parenterally transmitted infections in health-care personnel has become a challenge because of high costs, laboral incapacity and mortality, and social stigmatization. OBJECTIVES: To inform the incidence of occupational exposure in our institution, to determine the type of personnel affected and the circumstances of the injuries, and to assess the serologic follow-up of these employees. METHODS: The occupational injuries spontaneously reported to our infection control program from June 1987 to December 1993, were reviewed. Personnel categories, type of accident, instrument and circumstances of the injury, as well as serologic follow-up for hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV) infections, baseline and every three months during the first year were evaluated. RESULTS: In 6.5 years 260 injuries were registered in 240 workers. Two cases were registered in the second semester of 1987, 23 in 1988, 25 in 1989, 23 in 1990, 36 in 1991, 90 in 1992, and 61 in 1993. Housekeeping and maintenance staff were mainly affected (32%), nursing staff in second place (27%), followed by senior medical students (20%). Eighty-eight percent were sharp injuries (20% considered deep injuries). Most of the injuries occurred after instrumental utilization: sharp devices disposed without the use of adequate containers (18%), inappropriate handling of sharp containers (14%) and recapping needles (11%); 36% of the injuries occurred during specific procedures. One HBV seroconversion occurred in 10 surface antigen exposures, one in nine exposures with an HCV contaminated source, and none in 54 accidents with HIV contamination. CONCLUSIONS: The increase in the annual incidence of occupational exposures is due most probably to more awareness to report the injuries. Eighty-eight percent were sharp injuries and at least 43% could have been prevented. Our main educational and preventive efforts should be directed to housekeeping staff, nursing staff, and medical students of our institution.