The Seventh International Conference on AIDS, held June 16-21 in Florence, Italy, opened amid muted protest from demonstrators. Italian authorities had made it plain that the conference was to focus on science. Giovanni B. Rossi, director of the virology laboratory at the Instituto Superiore di Sanita in Rome and chair of the conference, told journalists to "expect a very different AIDS conference" from the political jamboree of meetings in previous years. As if to enforce decorum, the main auditorium was built inside the Fortezza da Bassa, a large fortress in the center of Florence whose entrance and exit consists of a single large gate.
Although no astounding breakthroughs were announced, the outlook was optimistic. Reports of definite progress in AIDS research were numerous.
* Slowed incidence, James Chin, M.D., M.P.H., chief of the surveillance, forecasting, and impact assessment unit of the Global Programme on AIDS, World Health Organization (WHO), described projections of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pandemic into the mid-1990s. [1] In industrial countries such as the United States, Dr. Chin said, HIV incidence--that is, the rate of new infections--is decreasing. Educational strategies designed to modify or eliminate risk behaviors continue to be the primary mode of intervention for preventing viral spread.
Nevertheless, the end stage, AIDS itself, develops over an average of 10 years after infection. Because of this long lag time, AIDS cases will be identified from existing pools of HIV-infected persons for many years.
WHO estimates that more than 1.5 million persons worldwide currently have AIDS and 8 to 10 million are carrying the virus. This means that one of every 250 people throughout the world is now infected with HIV. Dr. Chin painted a dismal picture for developing nations, where spread of the virus continues unchecked.
Anthony Fauci, M.D., chief of the AIDS research effort in the United States in his position as director of the National Institute of Allergy and Infectious Diseases, expressed optimism over progress in structural biology, pathogenesis, genetics, immunology, and other clinical research. [2] The recently achieved ability to determine the crystalline structure of the HIV protease and of the ribonuclease H domain of HIV-1 transcriptase, he said, could lead to targeted drug development.
Dr. Fauci described the structural delineation of the viral proteins as "paving the way for safe, specific, and effective inhibition of HIV." Although no vaccine is right around the corner, he said, the feasibility of creating one has been "firmly established." Dr. Fauci characterized the development of anti-HIV drug therapy as slow but real.
* Health care workers. The conference focused on concern over the exchange of HIV infection between health care workers and patients--in both directions.
A study of 52,000 patients' sera from 19 U.S. sentinel hospitals conducted by the Centers for Disease Control in Atlanta revealed that nearly 1% of all persons admitted to U.S. hospitals from July 1989 through June 1990 were infected with the AIDS virus. Almost one-third of infected patients had been admitted without a diagnosis that suggested the presence of the virus. Neither the patients nor their physicians suspected the presence of HIV infection, yet it was there. [3]
Gabor D. Kelen, M.D., associate professor and research director at the department of emergency medicine, Johns Hopkins University, Baltimore, examined the seroprevalence of 2,523 patients sequentially entering an emergency department who were seropositive for any of four viruses: HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and human T lymphotropic virus, type I or II (HTLV-I or -II). With this study Dr. Kelen expanded on one he had reported at the sixth annual international AIDS conference, held last June in San Francisco.
In the new study, an astonishing 89% of IV drug abusers in the group (155 of 175) harbored at least one of the four viruses. Twenty percent of the IV drug users were positive for the AIDS virus. Among patients who were transferred to the operating theater directly from the ER, 31.8% were positive for one of the four viruses--including 6.8% positive for HIV. The blood of patients whisked from ER to OR could not have been tested in time to determine their HIV status. Overall, the blood of six of every 100 patients in the Johns Hopkins study was positive for HIV. One in four patients was infected with at least one of the four targeted viruses. [4]
* Universal precautions. Statistics that emerged at the conference highlight the need for stricter and far more widespread adherence to universal precautions, personal protective equipment, and biosafety engineering controls in the clinical laboratory and elsewhere in the hospital.
Health care workers' compliance with universal precautions (UP) in the emergency departments of suburban community hospitals was the subject of a study by Keith Henry, M.D., director of the HIV/AIDS programs and clinic at the St. Paul Ramsey Medical Center, University of Minnesota, St. Paul. [5] Dr. Henry's findings indicate that compliance with universal precautions is extremely poor.
In the Minnesota study, a team of seven RNs observed 1,822 interactions between patients and health care workers at two suburban medical centers. Observed compliance with OSHA-mandated UP procedures was only 72% for gloves, 50% for goggles, 22% for masks, and 16% for gowns. The unsafe and widely discouraged two-hand procedure for recapping needles was observed 79% of the time.
At-risk exposures in health care settings were observed in a multicenter Italian study headed by Giuseppe Ippolito, M.D., chief of the AIDS unit at L. Spallanzani Hospital, Rome. Results showed that phlebotomy accounted for 30% of all needlestick injuries, of which 18% occurred while a worker was recapping a used needle by hand. [6]
A study on at-risk exposure similar to the one conducted in Rome was performed by Robyn Gershon, Dr.P.H., MT(ASCP), a research associate at the Johns Hopkins School of Hygiene and Public Health. Dr. Gershon's study, held at two Baltimore hospitals, found UP compliance to be poor despite a high perceived risk of exposure by health care workers to HIV-positive patients.
Dr. Gershon's background forged a clear path to her current work. A medical technologist who then became a laboratory administrator, she found that an increasing proportion of her job involved safety issues. Intrigued by the prospect and importance of promoting occupational safety and health in the laboratory, she obtained a master's degree in health science and then a doctorate in public health, specializing in occupational health for health care workers.
In Dr. Gershon's study, 40% of respondents said that they recapped their needles at least some of the time, 62% that they did not use eye protection, 37% that they did not use gloves when needed, and 40% that they did not use disinfectants when needed. Regarding activities specific to the clinical laboratory, 28% of respondents reported that they were still mouth pipetting and 55% said they unscrewed needles from evacuated blood-drawing tubes completely by hand--both considered highly unsafe activities.
This low compliance was surprising in light of a generally high level of understanding about HIV transmission. Reasons most frequently given for noncompliance were force of habit (22%), lack of time (19%), and equipment and supplies that were uncomfortable to use (13%). [7]
Dr. Gershon told MLO that medical technologists and other health care workers often failed to use gloves even when provided because "they wouldn't use gloves that didn't fit or gave them rashes. It had to be the 'right' glove." Asked specifically about medical technologists in an interview with MLO, Dr. Gershon declared, "Medical technologists need state-of-the-art protective equipment of the highest quality. We will continue to lose laboratory workers because of inadequate supplies and inadequate quality of those supplies. Administrators must wake up to the fact that providing high-quality protective equipment is far less expensive than losing laboratory workers; turnover in the clinical laboratory is costly."
Dr. Gershon suggested that laboratory administrators acknowledge workers' fear of AIDS rather than minimizing it, as has been the case. She believes that administrators have damaged their own credibility among their staff by downplaying risk. The likelihood of being infected with HIV after a needlestick with a specimen that is known to be positive fo the virus, she noted, is 1:300--a ratio not to be taken lightly. Medical technologists need better risk information, she concluded, and they need to have it reinforced over and over again.
1 2 3 Continued »
