1. AIDS in the workplace AH Mehrparvar,MD Occupational Medicine department Yazd University of Medical Sciences

2. Introduction  Human Immunodeficiency Virus  A retrovirus  HIV-1 and HIV-2  RNA and reverse transcriptase  Enters cells expressing CD4 (a group of T lymphocytes)

3. Transmission of HIV  HIV isolated from: Blood Semen Vaginal secretion Breast milk and:  Saliva  Tear  urine

4.  75% of all HIV infections are due to sexual intercourse  Blood and blood products  Maternal-infant

5. Diagnostic tests  Screening Ab against HIV (4-12 weeks later) False positive: multiple pregnancies, transfusion, autoimmune diseases  Confirmatory Western blot: negative, indeterminate, positive Virologic markers

6. Pathogenesis  Acute or primary infection Fever, fatigue, pharyngitis, LAP, myalgia, rash  Asymptomatic phase 7-10 years  Symptomatic phase CD4<200/mm 3 Opportunistic infections:  Fungal infections  Herpes simplex  TB

7. Occupational risk of HIV  Directly proportional to the risk of exposure to HIV-infected blood  Jobs:  HCWs  Military personnel  Safety/rescue personnel  sporstmen

8. HCWs  Most common: needlestick  RR of percutaneous infection: 1 in 300  Influencing factors: Quantity and depth of infection Visible blood on needle Terminal AIDS  Other exposures: Intact skin with large quantities of blood Mucous membrane exposure

9. Primary prevention  Minimizing contact with moist body substances and surfaces, by:  Handwashing With warm water and plain soap Antimicrobila agents are not necessary  Gloves  Gowns  Face shields

10. Primary prevention  Do not recap needles  Put disposable syringe, needle and other sharp devices in puncture-resistant containers  Put containers as close as possible to use areas  Clean-up spills of blood or other body fluids with suitable germicide  Dispose of gloves last  Wash the hand after disposing gloves

11. Secondary prevention  After needlestick:  Cleanse wounds  If source seronegative: Baseline test and follow-up 12 weeks later  If source unknown or positive: Chemoprophylaxis  Zidovudine during 72 hours after exposure Baseline test ant follow-up at 6, 12, and 26 weeks

12. Sportsmen  Do not recommend routine testing  Do not restrict HIV-positive athletes from playing

13. Military personnel  They may not serve in combat units  They may not be assigned remote from medical centers

14. Mortuary workers  HIV in blood up to 21 hours after death  HIV in bone, brain and viscera after 2 weeks