국내 의료 종사자의 HIV 노출 및 postexposure prophylaxis에 관한 조사

Abstract

Background: As of 30 September 2001, a total of 1,515 human immunodeficiency virus (HIV) infected persons has been reported in Korea. The number of newly infected persons tends to increase year by year, with the result that the contacts between HIV infected persons and health care workers (HCW) become more frequent. This survey was to investigate the current state of occupational HIV exposure and postexposure management among HCW in Korea.

Methods: We surveyed retrospectively the cases of occupational HIV exposure reported until the fist half of 2001, in total 14 tertiary teaching hospitals. We reviewed these cases for the details about : i) exposure type, medium and depth of injury, ii) postexposure prophylaxis (PEP) and follow up serologic test, and iii) source patients.

Results: Forty-eitht cases (65% female, no pregnant woman) of occupational HIV exposure were identified. The number of cases tends to increase rapidly in recent two years. The majority of this exposure occurred in nurses and doctors, after percutaneous needle stick injury. The mean time from exposure to administration of PEP drugs was 20 hours Of 39 cases receiving the PEP drugs, 62% completed all of the drugs as initially prescribed and 31% discontinued all PEP drugs. The reasons for discontinuation included adverse events (9 cases), health care provider judgment (1 case), and source patient HIV negative (1 case). There was all least one adverse event in 59% of cases receiving the PEP drugs. The most frequent adverse events were gastrointestinal symptoms such as nausea, vomiting, anorexia, and indigestion. So far, there has been no HCW infected with HIV via occupational exposure.

Conclusion: Although primary prevention remains the best strategy for protecting HCW from occupational HIV transmission, exposures are nevertheless likely to occur. Systematized PEP programs that include written protocols for prompt reporting, evaluation, counseling, treatment, and follow-up of occupational exposures will be needed for the secondary prevention.