Elbirt Daniel, Levy Itzhak, Asher Ilan, Mahlev-Guri Keren, Rosenberg-Bezalet Shira, Litachevsky Slava, Radian-Sade Sara, Sthoeger Zev
Internal Medicine B and the Altergy, Clinical Immunology and AIDS Unit, Kaplan Medical Center, Rehovot affiliated to the Medical School, Hebrew University, Hadassah, Jerusalem.
Harefuah. 2013 Apr;152(4):224-9, 246.
During recent years, the use of antiretroviral therapy expanded beyond the treatment of HIV-infected patients. Since the outset of the HIV epidemic, antiretroviral drugs were also used for post-exposure prevention of HIV infection in health workers and implemented after possible exposure during sex. In this study, we summarize the cases from the AIDS center in the Kaplan Medical Center and the Sheba Medical Center after possible exposure to HIV (occupational or sexual).
The study aims to validate the different types of potential exposures to HIV encountered, the treatment and outcomes.
All the data regarding attendance at the AIDS Center in the Kaplan Medical Center during the years 2008-2010 for any possible HIV exposure (occupational or sexual) and for sexual exposure in the Sheba Medical Center AIDS Clinic during the years 2003-2008 was collected retrospectively.
During the years of the study, 448 patients attended the Kaplan Medical Center for consultation after a potential exposure to HIV; 314 of the cases were because of occupational exposure, however, only in 11 (3.5%) of the cases, post exposure prophylaxis (PEP) treatment was advised. In the other 134 patients who attended for non-occupational potential exposure to HIV (18 cases of needle stick or sharp object injury and 116 of sexual exposure), for 46 (40%) of these cases, PEP was recommended. No evidence of HIV infection was found for any of the 448 patients who attended the clinic for possible exposure to HIV, regardless of the consultation that they received. In the Sheba Medical Center, during the years 2003-2008, 175 patients attended for consuLtation after potential sexual exposure to HIV. The medical staff of the clinic decided, after risk assessment, to recommend PEP to 140 (80%) of the cases. Similarly, in this case, no evidence of HIV infection was found (regardless of whether PEP was given or not).
In potential occupational exposure to HIV it is possible, in most cases, to assess the risk for infection sufficiently so that only a few cases will need PEP. In potential sexual exposure to HIV, there are many cases where data regarding the potential source of infection is partial or missing, making the risk assessment more difficult. This may be the reason for the high percentage of patients in this situation who received PEP. From the data in this study, our cohort support PEP as being effective and safe.
近年来，抗逆转录病毒疗法的应用范围已从治疗感染艾滋病毒的患者扩展到其他领域。自艾滋病毒流行开始以来，抗逆转录病毒药物也被用于医护人员暴露后预防艾滋病毒感染，并在性行为后可能暴露于艾滋病毒的情况下使用。在本研究中，我们总结了卡普兰医疗中心和谢巴医疗中心艾滋病中心在可能暴露于艾滋病毒（职业性或性接触）后的病例。
本研究旨在验证所遇到的不同类型的潜在艾滋病毒暴露情况、治疗方法及结果。
回顾性收集了2008年至2010年期间在卡普兰医疗中心艾滋病中心因任何可能的艾滋病毒暴露（职业性或性接触）就诊的所有数据，以及2003年至2008年期间在谢巴医疗中心艾滋病诊所因性接触就诊的数据。
在研究期间，448名患者因潜在的艾滋病毒暴露到卡普兰医疗中心咨询；其中314例是职业暴露，但只有11例（3.5%）被建议进行暴露后预防（PEP）治疗。在另外134名因非职业性潜在艾滋病毒暴露就诊的患者中（18例针刺或锐器伤和116例性接触），其中46例（40%）被建议进行PEP治疗。在这448名因可能暴露于艾滋病毒而到诊所就诊的患者中，无论他们接受了何种咨询，均未发现艾滋病毒感染的证据。在谢巴医疗中心，2003年至2008年期间，175名患者因潜在的性接触艾滋病毒后前来咨询。诊所的医务人员在进行风险评估后，决定对140例（80%）患者建议进行PEP治疗。同样，在这种情况下，也未发现艾滋病毒感染的证据（无论是否给予PEP治疗）。
在潜在的职业性艾滋病毒暴露中，在大多数情况下，可以充分评估感染风险，因此只有少数病例需要进行PEP治疗。在潜在的性接触艾滋病毒暴露中，许多情况下关于潜在感染源的数据不完整或缺失，使得风险评估更加困难。这可能是在这种情况下接受PEP治疗的患者比例较高的原因。从本研究的数据来看，我们的队列研究支持PEP是有效且安全的。
