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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Royal Free NHS Trust is implementing a Universal Precautions policy for blood and body fluids. Anticipating the introduction of this policy, a questionnaire was sent to a sample of staff and students who work with patients or clinical specimens. The questionnaire covered: views about identifying 'high risk' patients and specimens; perceived risks of human immunodeficiency virus (HIV) and hepatitis B infection from blood exposures; and current practices to avoid exposure to blood. Over half the respondents thought it important to identify high risk patients and specimens. Such respondents were more likely to overestimate the risks of HIV and hepatitis B virus transmission after blood exposures, they were less likely to wear gloves and more likely to resheathe needles. Although two-thirds of respondents thought Universal Precautions would reduce their risk of blood-borne infections, they identified a number of reasons why it would be difficult for them to practice it. Those who thought it important to identify high risk patients gave more reasons than other respondents. This survey indicates that many staff believe it is important to identify high risk patients and this belief seems to influence clinical practice. In order to implement a policy of Universal Precautions successfully, it is necessary to address underlying beliefs as well as giving staff information and training.
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PMID:Clinical practice and the perceived importance of identifying high risk patients. 784 46

We previously reported that truncation of the terminal 146 amino acids of the macaque simian immunodeficiency virus SIVmac239 envelope glycoprotein enhanced envelope-specific syncytium formation in HeLa T4, CEM X 174, and HUT 78 cell lines and caused a change in the conformation of the transmembrane subunit of the envelope complex on the surface of these cells [Ritter et al. (1993) Virology 197, 255-264; Spies et al. (1994) J. Virol. 68, 585-591]. To investigate the effects of different lengths of the cytoplasmic domain on syncytium formation and cell surface expression, we have compared the expression and cytopathic effects induced by five SIVmac239 envelope constructs which vary in the lengths of their cytoplasmic domains. In contrast to the envelope protein truncated by 146 amino acids, the ability of proteins truncated by 98 or 161 amino acids to form syncytia was substantially reduced in CEM X 174 and HUT 78 cells, while syncytium formation by a protein truncated by 53 amino acids was only slightly reduced compared to the full-length protein. Furthermore, only the glycoprotein which was truncated by 146 amino acids induced syncytium formation in HeLa T4 cells. When examining the expression of the truncated proteins on the surface of HeLa T4 cells, we found that, in contrast to the full-length SIVmac239 protein, each of the truncated transmembrane subunits could be efficiently biotinylated with the membrane-impermeable reagent NHS-SS-biotin. Furthermore, using cell surface iodination, we found stable oligomeric forms of both the transmembrane subunits and the uncleaved precursor proteins of each mutant protein on the surface of HeLa T4 cells. Using pulse-chase analysis, we also found that the precursor of the protein truncated by 98 residues was degraded more rapidly than the wild-type and the other mutant proteins. Finally, we constructed two mutants which expressed a full-length TM protein or a TM protein with a 146 amino acid C-terminal deletion and had most of the coding sequences of their SU subunits deleted. Neither of these two proteins was found to cause syncytium formation in HeLa T4, CEM X 174, or HUT 78 cell lines even though we could detect both proteins on the surfaces of HeLa T4 cells using iodination. These results could explain why the selection of truncated variants of SIV which emerge after prolonged passage in human cell lines is restricted to truncations which remove close to 146 amino acids in the cytoplasmic domain of the TM protein.
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PMID:Effects of cytoplasmic domain length on cell surface expression and syncytium-forming capacity of the simian immunodeficiency virus envelope glycoprotein. 803 Feb 87

A 6-month retrospective self-administered questionnaire study of 482 doctors and 380 midwives in two NHS Trusts was undertaken. The response rate was 384 (80%) and 293 (77%) respectively. The study revealed that only nine per cent of doctors and 46% of midwives had reported the contamination incidents they had received. The doctors' main reason for non-reporting was 'too time consuming' and midwives' was 'did not consider anything could be done', although their awareness of the active management of contamination incidents by occupational health departments was good. Seventy-seven per cent of doctors and 69% of midwives underestimated the risk of contracting hepatitis B virus from a needlestick injury, whilst 52% of doctors and 36% of midwives underestimated the risks of acquiring infection with HIV (human immunodeficiency virus) infection following such an injury. Strategies for improving the knowledge of the potential risks of contamination incidents and methods for facilitating ease of reporting are discussed.
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PMID:Contamination incidents among doctors and midwives: reasons for non-reporting and knowledge of risks. 932 39

A serophobia of the human immunodeficiency virus type 1 (HIV-1) is very noticeable in mortuaries handling high-risk cases. The morbid anxiety about occupationally acquired HIV infection in the forensic practice has made mortuary workers unduly overcautious. Despite the availability of codes of practice and informed principles of health and safety, there is considerable anxiety that an HIV carrier with no identifiable risk factors may be overlooked or a seronegative body may be inadvertently assumed to be uninfected. In contrast, a false sense of safety can pose a health hazard and has public health implications. An algorithm system is outlined for selective handling of unsuspected or unrecognized high-risk cases. It is necessary that guidelines are reasonably simple and incorporate statutory health and safety regulations and local safe working practice in the mortuary. Although it is not a legal obligation, approval by the coroners should facilitate consistent implementation of a protocol. A common experience in public and NHS hospital mortuaries in the London coroners' jurisdictions is characterized.
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PMID:HIV serophobia in the mortuary: an algorithm system for handling high-risk forensic cases. 938 38

The last two decades have seen a substantial increase in the use of protective gloves in healthcare establishments. This is attributed to the widespread publicity regarding the risks of transmission of human immunodeficiency virus and hepatitis B and C from blood and body fluid contact. Further, directives from official agencies stressing the need to protect staff from blood-borne viruses in the workplace led to the introduction of a variety of disposable gloves, each claiming total or adequate protective ability. The resulting sensitization to latex in some users has caused concern. This article reports on the process used within one NHS trust to explore glove use and determine the level of latex sensitization among staff. The audit identified an irrational approach to glove purchasing as well as inappropriate use of different types of gloves. The audit was followed by a trial aimed at rationalizing both the purchase and use of gloves.
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PMID:Rationalizing the purchase and use of gloves in health care. 1036 28

Often the provision of post-exposure prophylaxis (PEP) is after exposure to persons with an undetermined human immunodeficiency virus (HIV) status. Cases of occupationally acquired HIV infection have been documented. The risk of contracting HIV from percutaneous exposure is small and PEP can significantly reduce the rate of occupational transmission. The Department of Health recommends that PEP be considered whenever there is significant exposure to high-risk body fluids, e.g. blood or other high-risk body fluids such as synovial or cerebrospinal fluid. It is important that a risk assessment is conducted to ascertain if the exposure is deemed significant. If it is, in an ideal situation, PEP should be commenced immediately, preferably within 1 hour; however, starting PEP up to 2 weeks after exposure may still be beneficial. All NHS and other healthcare settings, including the independent/private sectors, should ensure that they have policies and procedures in place to ensure that their staff are aware of the actions to be taken if they are at risk of occupational exposure to HIV.
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PMID:Occupational exposure of staff to HIV and prophylaxis therapy. 1557 9

Health care workers are at risk of exposure to blood and body fluids from their patients through needlestick injuries or contamination of mucous membranes - a slash of blood in the eye, for example. Exposure to blood /body fluids is now the second biggest cause of occupational injury among NHS workers (UNISON, 2003). The first example of a case of occupational exposure of a health care worker to human immunodeficiency virus (HIV) and subsequent seroconversion following a needlestick injury was reported in the 1980s. This incident raised awareness of the risk that health care workers face when they are exposed to blood-borne viruses, in particular hepatitis B, hepatitis C and HIV.
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PMID:Exposure to blood or body fluids: management for health care. 1621 23

Replication of the human immunodeficiency virus (HIV) is dependent upon the enzyme HIV integrase (IN), one of three essential enzymes encoded in the viral genome. HIV-1 IN catalyzes the insertion of the proviral DNA into the host genome (strand transfer). HIV-1 IN therefore presents an attractive chemotherapeutic target for the treatment of HIV infection and AIDS that could provide patients and physicians with an additional option for treatment. Assays were developed to identify inhibitors of IN strand transfer. Diketoacid lead compounds were explored and developed into a variety of heterocyclic templates that are potent inhibitors of integrase strand transfer with suitable medicinal chemical properties for treating HIV infection and AIDS. The 1,6-naphthyridine L-870810 (Antiviral activity in cells IC(95) NHS = 102 nM, n=237), was shown to be efficacious in reducing viral RNA by 1.7 log units after doses of 400mg BID to HIV infected patients. Optimization of physical properties led to L-900564, an inhibitor of HIV IN that has excellent cell potency in the presence of protein (Antiviral activity in cells IC(95) NHS = 16 nM, n=15), excellent activity against mutants raised to HIV integrase inhibitors, and a very good pharmacokinetic profile.
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PMID:HIV integrase inhibitors: from diketoacids to heterocyclic templates: a history of HIV integrase medicinal chemistry at Merck West Point and Merck Rome (IRBM). 1762 56

Health care professionals are exposed to blood and other body fluids in the course of their work: (Al-Benna et al 2008). The World Health Organisation (2003) estimates that 9% of the 35 million healthcare professionals worldwide will experience percutaneous exposure to bloodborne pathogens each year (WHO 2003). In the U.K. about 100,000 sharps injuries occur in NHS hospitals each year (Trim & Elliott 2003). This is 17% of all accidents involving NHS staff (NAO 2003). Four percent of NHS staff sustain from 1 to 6.2 sharps injuries each year. These injuries occur mainly in clinical areas such as wards and theatres, but also in non-clinical areas due to accidental handling of inappropriately discarded sharps (Trim & Elliott 2003, Waterson 2004). Percutaneous injuries involving hollowbore needles remain the most commonly reported occupational exposures in the healthcare setting (HPA 2010). Consequently, workers are at risk of infection with bloodborne viruses including human immunodeficiency virus, hepatitis B virus, hepatitis C virus and bacterial infections (Al-Benna et al 2008).
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PMID:Needlestick an sharps injuries among theatre care professionals. 2126 3

Background HIV has changed from a rapidly deteriorating illness to a complex chronic disease, with increasing incidences of comorbidity, including cancer, and liver, lung and cardiovascular diseases. North West London has 6719 individuals living with the human immunodeficiency virus (HIV), 873 of whom reside in the London Borough of Brent. Traditionally, commissioning services have focused on HIV therapy alone without considering how comorbidity affects treatment outcome and total service costs. Setting The setting for the study was NHS Brent Primary Care Trust, London UK. Question What associated comorbidities are present in people in Brent (London, UK) living with HIV, and how common are they? Methods A point-prevalence audit of retrospective data was conducted on all HIV-positive patients in Brent (financial year 2011/12). Data were collected from genito-urinary medicine (GUM) services, community services and general practitioners (GPs) on HIV diagnosis, patient demographics and past/current comorbidities: hepatitis B and C, cardiovascular disease, diabetes and mental health disorders. Results This study identified that 29% of people living with HIV/AIDS (PLWHA) in Brent have at least one comorbidity. The most common was hepatitis, followed by mental health disorders and cardiovascular disease (CVD). Comorbidity was more likely in older male patients (in particular CVD and diabetes) and White patients (except for diabetes which was more common in Asian groups). Discussion/Conclusion Many PLWHA in Brent suffer from a number of other conditions, which appear largely independent of HIV. Findings confirm the need to treat HIV as a long-term condition, including patient education, empowerment and encouraging self-management. The multi-morbidity of many PLWHA suggests a role for both primary care and collaborative, holistic, patient-centred and individualised healthcare. Service providers and commissioners need to consider comorbidities in their treatment of and provision of services for PLWHA. This study also highlighted the need for services to address limitations of their data collection systems.
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PMID:The prevalence of comorbidities among people living with HIV in Brent: a diverse London Borough. 2594 22


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