HIV职业暴露嫉陌其预防和治疗上海市(复旦大学附属)公共卫生中心复旦大学附属华山医院感染科 -卢洪洲.ppt

Occupational Exposure Management of HIV Post-Exposure Prophylaxis HIV职业暴露及其预防和治疗;2004年四季度HIV报告16477，病人2036，死亡467，全年HIV报告47606例，占历年累计报告总数44.5%，是2003年的2.2倍。85年以来HIV（+）106990，23955例AIDS，死亡5598。新兵体检HIV（+）1.6/万。;因锐器刺伤引起的感染(source: Collins Kennedy, 1987);Herpes simplex lesion of the palm six days after a needlestick injury;HIV传播途径;传染危险性?;Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd.;;HIV in Body Fluids;HIV Transmission;暴露类型;体液/组织类型;直接接触高浓度病毒(实验室;疾病终末期) 不具有潜在传染性，除非含有血液: 粪便 ?鼻腔分泌物 唾液 ? 痰 眼泪 ?汗液 尿液 ?呕吐物;What does the risk of transmission depend on ?; Worldwide, the first documented case of HIV transmission from patient to HCW was a UK nurse who sustained a needle stick injury whilst obtaining blood from the arterial line of an African patient with AIDS. (Anon., Lancet, 1984, ii:1376-7) 美国亚特兰大疾病控制与预防中心统计从2001年12月至2004年4月已经确诊57例AIDS职业暴露感染者，此外还有138例AIDS病人其感染途径可能与职业暴露有关。 ;Documented HIV seroconversion after a specific occupational exposure (data to Dec 1999);Documented Occupational Seroconversions – UK;;;Occupational HIV Infection;Source Fluids for Exposures Resulting in Occupational HIV Transmission ;U.S. Health-Care Workers with DocumentedOccupationally Acquired HIV Infection, by Occupation through June 1999; PEP in Humans / HCW;英国职业暴露后预防指导意见;Exposure Risk;Exposure Risk;Risk Factor Adjusted Odds Ratio (95% CI) 深刺 16.2 (6.1-44.6) 可视性出血 6 (1.8-17.7) 终末期病变 6 (2.2-18.9) 进入血管 4 (1.9-14.8) 服用ZDV 0.2 (0.1-0.6) Cardo et al., NEJM;1997;337:1485-90 (updated);健康工作者中的HIV血清转换 ;我国尚未有因医务界职业暴露而感染 HIV的报道 广州八院13名医务人员职业暴露 地坛医院;地坛医院HIV职业暴露;艾滋病病房22名医务人员10年来HIV/AIDS暴露情况;8位医务人员职业暴露的原因及暴露的程度（昆明）;ZDV PEP Treatment Failures in HCWs;“Window Period”;IMMEDIATE TREATMENT OF EXPOSURE SITE;对暴露和暴露源的评估; Post Exposure Prophylaxis;动 物 实 验;预防用药动物试验: 用Tenofovir (阿德福韦双特戊酰氰基甲酯，300mg每日一次)预防短尾猴感染SIV ;预防用药动物试验: 用Tenofovir