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Clinical Observation |

Investigations of Possible Failures of Postexposure Prophylaxis Following Occupational Exposures to Human Immunodeficiency Virus

Elise M. Jochimsen, MD; Chi-Cheng Luo, PhD; John F. Beltrami, MD; Richard A. Respess, PhD; Charles A. Schable, MS; Denise M. Cardo, MD
Arch Intern Med. 1999;159(19):2361-2363. doi:10.1001/archinte.159.19.2361.
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Information suggesting that zidovudine postexposure prophylaxis (PEP) reduces the risk of human immunodeficiency virus (HIV) transmission after occupational exposure to HIV-infected blood prompted the US Public Health Service to provide guidelines for the use of combination drug therapy for chemoprophylaxis after certain occupational exposures to HIV.1,2 Many health care workers (HCWs) worldwide may take PEP following occupational exposures to HIV.

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Phylogenetic analysis of human immunodeficiency virus (HIV) samples based on the C2V3 sequence of the env gene. These sequencing results were independently confirmed by Rob Schuurman, PhD, University of Utrecht, Utrecht, the Netherlands. The strains of HIV infecting the health care workers (HCWs) and source patients (SPs) were compared after amplification by polymerase chain reaction and genetic sequencing. The phylogenetic tree was constructed using the neighbor-joining method. Vertical distances are for clarity only; the length of the horizontal distances are proportional to percent nucleotide changes between sequences and can be read using the scale bar provided. Numbers at the nodes are bootstrap values, generated through a data resampling procedure to show the likelihood for which sequences can be sorted into a cluster. Clusters that are present in 70% or more bootstrap values are considered to be statistically significant and indicate that variants of HIV are more likely to be highly related. In case 1, SRC1-1 and SRC1-2 denote virus from the 2 SP blood sample draws, and HCW1-1 and HCW1-2 denote virus from the 2 HCWs blood sample draws. While SRC1-1 and SRC1-2 were highly related, providing support that the 2 viruses were from the same SP, HCW1-1 and HCW1-2 appeared unrelated to each other and unrelated to the SP virus. In case 2, virus from the SP and HCW (SRC2 and HCW2, respectively) were not related. Other HIV sequences denote HIV reference strains.

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