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HIV

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HIV

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    1. HIV??????????? ???????? ????? ????? ???

    2. ?????????? ???? ???? ???? ???????? ???(??)?? ?????

    3. ??????? ?????? ?? ????!

    4. ??????? ????? SARS

    5. ???????(??=5µm) ?? ????????????? ???????? A?????? ????? ?? ???? ??? ??? ????

    6. ??????? ???????? B????? C????? ?? ???? ?? ?????? ??? ??????

    7. ????????—??? ??????????????????????????????,??????????????????,????? ??,??????????,??????????????,??????????????????? ?????,?????,??????????????????????????????????????????,??????????????????,????? ??,??????????,??????????????,??????????????????? ?????,?????,????????????

    8. ????????—???? ????????? ??????????????? ???????? ???????? ?????? ???????????,?: ????????? ????? ????????? ???????? ????????,????? ???????????? ???????????????????,??????????????,??????,?????????,????????,?????????,?????????,???????! ???????????,?: ????????? ????? ????????? ???????? ????????,????? ???????????? ???????????????????,??????????????,??????,?????????,????????,?????????,?????????,???????!

    9. ????????—???? ???????---900/1,000 ????????---3/1,000 ???????????????---6.7/1,000 ???????????,??? ?????1.34? ??: 1/150 ??3-5?:1/30-50 ???3-5?,?????????????????100% ?????????????????? ???????????,?: ????????? ????? ????????? ???????? ????????,????? ???????????? ???????????????????,??????????????,??????,?????????,????????,?????????,?????????,???????! ???????????,?: ????????? ????? ????????? ???????? ????????,????? ???????????? ???????????????????,??????????????,??????,?????????,????????,?????????,?????????,???????!

    10. ????????— ?????? ???????????,??????,??????????????,??????????,????????, ????????HIV???????????????,??????,??????????????,??????????,????????, ????????HIV????

    11. ????????— ?????? ??:25-40% ??:60-75% ??:15-25% ???????????,??????,??????????????,??????????,????????, ????????HIV???????????????,??????,??????????????,??????????,????????, ????????HIV????

    12. CDC, MMWR1987;36;2S ?????? ???? CDC?1987????????????(Universal Precaution)??,???????????,?????????????,?????????? ??????,?????????????????HIV?B??????C?????????

    13. HIV????? ??????????? HIV????????:???? Percutaneous injury Mucous membrane or non-intact skin Infectious body fluids (???????): Blood or body fluids containing blood Semen, vaginal secretion, CSF, synovial fluid, pleural fluid, peritoneal fluid, amniotic fluid

    14. ????????????????????

    15. ????????? B?????(HBV) : 20-40% (30%) C?????(HCV) : 1-10% (3%) ????????(HIV)?? : 0.1-0.4% (0.3%) HIV????????:?????????????? ????????????? ?HBsAg?anti-HBs?????????????????HBV????

    16. ??????????????? ??????????????? ?????????? ????,????????????? ??????????????? ??????,??????????? ???????????0.3% ???????????0.09%

    17. ?HIV?????? ??????? ????????????? ???????? ??????? ???????????????? ????????????? ????????????? ?????????????? ?????????????????? ???????????

    18. ??????HIV????? ?????? (odds ratio [OR] 15) ?????????? (OR 6.2) ??????????????? (OR 4.3) ?????????? (OR 5.6) Type of needle (hollow bore or solid) Size of needle Source patient’s viral load Amount of blood Duration of exposure Immune status of HCW

    19. ???????? ???????? ???????? ?????????????(alcohol-based hand hygiene agent)???? ?????? ???????? ???? ????????

    21. Management of Exposures Follow-up of HIV: Source anti-HIV (+): Testing for anti-HIV at 6 weeks, 3 months, and 6 months (1 year for HCV sero-conversion) Testing for anti-HIV if illness compatible with an acute retroviral illness occurs. Source anti-HIV (-) and no evidence of AIDS and acute HIV infection: No indication of follow-up testing

    22. ?????????

    23. ???????? Universal Precaution (?????) ??????????? (?????????) ?????????!

    24. ??????????? ??????????????

    25. ????????? Post-Exposure Prophylaxis (PEP) ???????,????????????????????? ??????????????????????: HIV, HBV, HCV, ?? ?????????????????: HIV?????????,??????????????90% HBV???,???????????7? HCV????????????????????,?????????

    26. PEP for HIV Exposures Role of pathogenesis in considering PEP Not immediately systemic infection Brief window to modify / prevent Studies of S (simian) IV: First 24 hours: local dendritic-like cells Subsequent 24~ 48 hours: to regional LN SIV in peripheral blood within 5 days

    28. PEP for HIV Exposures Efficacy of PEP in Animal Studies: Viral inoculum, dose of PEP, duration of PEP, time lag to initiate PEP Tenofovir study for SIV: 4 weeks, initiated within 48 hours: success 3 ~ 10 days or initiated 48 ~ 72 hours: incomplete prevention

    29. PEP for HIV Exposures Efficacy of PEP in Human Studies: Retrospective case-control study of HCP: ZDV associated with a 85% reduction in the risk of HIV infection ZDV for HIV-infected pregnant women: Used during pregnancy, labor, delivery and to infant 67% reduction of HIV transmission to infant

    30. PEP for HIV Exposures Reports of Failure of PEP: At least 21 instances 16 cases, use ZDV only 2 cases, use ZDV and DDI 3 cases, use more than 3 drugs Potential causes: Resistance of HIV, delayed initiation = 48hrs, inadequate drug / dosage, larger inocula

    31. PEP??? ??????????,???????24?????????,??100%?????????? ?24~48????????5??? ~ Tsai C-C et al. J Virol 1998;72:4265-73. ??????28?? ????????????????,?????,??????????

    33. ??HIV?????? ???????:???????????(<1500 c/mL) ?CD4+????? ???????:????????????????CD4+????? ????? ????:???????? ????:?????????? ?????? ??:???????????????????????????? ????:????????

    36. ??????????? ????HIV??,?????????????? ????????????????????? ???????,???7?????????? ??????,?????AZT????????,????? ???????? ????????????????? ?????????????????????? ????? ????????????????

    37. How To Reduce Risk? Number of procedures Double gloves (?) Gowns, facemasks, goggles. Care during procedures where splattering of blood is anticipated Use of impervious needle-disposal containers Transport of samples in sealed containers

    38. ?????????????????? ?????6~12???,????????????: ??????????,???????? ?????? ?????: ?????: ???6??3?6?9??????????? ??????? ???????????

    39. HBV???? ?????????????????????? ????B?????,???????95% ?????????????10 IU/ml?B??????? HBV ?PEP: HBIG (hepatitis B Immune Globulin) B???????????????????? ???????????

    40. http://www.cmesh.org.tw/????????????????-950820.pdf B?????????????

    41. HCV???? HCV???????????1.8% ??????????????HIV???? ????????????PEP?? ?????????????,?????????????????,???????????????

    42. C????????????? ?????????? ????????HCV?RNA???,????? ?HIV?????,HCV???????????

    43. ??????????-EPINet????????????????(93/1~95/5) EPINet????????????????(93/1~95/5)

    44. ??????????-EPINet????????????????(93/1~95/5) ???????????

    45. ??????????-EPINet????????????????(93/1~95/5)

    46. ????????????????????? ????CDC?1922??,?????????????????????????,?????1922?? (??)? ??????????????????,??????,?????????????? ??????????????????????,?????????,?????????????? ????????:0800-888-995

    47. ?????????? ???????????????,?????????????????,???????,??????????? ????????????????96??1????? (5/22??) : ????????????????????,????????????????,??????????,?????????????

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