Rapparini Cristiane
Infectious Diseases Service, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, and the STD/AIDS Department, Health Secretariat of Rio de Janeiro City, Rio de Janeiro, Brazil.
Am J Infect Control. 2006 May;34(4):237-40. doi: 10.1016/j.ajic.2005.08.016.
Exposure to bloodborne pathogens poses a serious risk to health care workers (HCWs). Surveillance systems of occupationally acquired human immunodeficiency virus (HIV) infection have been developed in several countries, mainly in the developed world. The purpose of this study was to identify cases of occupationally acquired HIV infection among HCWs in Brazil.
A systematic literature review was conducted. The databases searched were MEDLINE and LILACS (1981 to 2004), academic dissertations and theses (1987 to 2004), abstracts from national and international meetings during the last 10 years, and local and national bulletins. Reference lists to identify other relevant articles were checked.
The database searches generated a total of 60,770 titles. Two hundred and nineteen references were finally analyzed. Four documented cases of occupational HIV infection were identified. All of the cases involved nursing staff and were percutaneous exposures. Seventy-five percent occurred after a procedure involving a needle placed directly into a vein or artery. Most (75%) had source patients with probable high viral load and low CD4 count. Two cases represented HIV seroconversion despite initiation of postexposure prophylaxis. Only one case (1/4; 25%) presented acute retroviral illness.
After an extensive literature search, 4 documented occupational HIV infection cases were identified, only 1 of which had been published in a scientific journal. Our findings were consistent with the majority of documented infections worldwide. Surveillance systems are indispensable to establish and formulate rational policies for minimizing the risk of occupational infection, not only from HIV but also from hepatitis B and C viruses and other bloodborne pathogens.
接触血源性病原体对医护人员的健康构成严重风险。一些国家，主要是发达国家，已经建立了职业性获得性人类免疫缺陷病毒（HIV）感染监测系统。本研究的目的是确定巴西医护人员中职业性获得性HIV感染病例。
进行了系统的文献综述。检索的数据库包括MEDLINE和LILACS（1981年至2004年）、学术论文和学位论文（1987年至2004年）、过去10年国内外会议的摘要以及地方和国家公告。检查参考文献列表以确定其他相关文章。
数据库检索共产生60770个标题。最终分析了219篇参考文献。确定了4例有记录的职业性HIV感染病例。所有病例均涉及护理人员，且为经皮暴露。75%的暴露发生在涉及直接将针头插入静脉或动脉的操作之后。大多数（75%）的源患者病毒载量可能较高且CD4细胞计数较低。尽管进行了暴露后预防，仍有2例出现HIV血清转化。只有1例（1/4；25%）出现急性逆转录病毒疾病。
经过广泛的文献检索，确定了4例有记录的职业性HIV感染病例，其中只有1例发表在科学期刊上。我们的研究结果与全球大多数有记录的感染情况一致。监测系统对于制定和制定合理政策以将职业感染风险降至最低至关重要，不仅是HIV感染风险，还包括乙型和丙型肝炎病毒及其他血源性病原体感染风险。
