On the 5th, Feng Tiejian, an “AIDS prevention” expert from the Shenzhen Epidemic Prevention Station, told reporters that after encountering sexual violence and having unprotected sex with HIV-infected people (or suspected patients), it is possible to avoid contracting AIDS within a short period of time through preventive drug treatment. The drug prophylaxis can also prevent HIV infection.
“People who have had unprotected intercourse with HIV-infected persons (or suspected patients) after certain sexually violent crimes can actually be prevented with drugs, reducing the rate of HIV infection to 79%. But there has been no publicity on this in the past.” Feng Tiejian said that the current professional drugs used to block HIV are not equipped in general hospitals, Guangdong currently only the provincial health prevention station and Shenzhen health prevention station has AZT, double Tidezhi and other anti-HIV professional standing drugs, suspected of being infected as far as possible within 1 hour to start taking drugs, such as more than 4 hours to reduce the effectiveness of taking drugs, more than 24-36 hours may not If the risk of infection is high, even if you are not infected, you should take the medication. If the risk of infection is high, even if the interval is long (such as 1-2 weeks) should still consider drug prophylaxis, because even if there is no protective effect, for the early treatment of acute infection is also beneficial.
However, according to Feng Tiejian, drug prophylaxis should never be given as a routine or whenever the patient requests it, considering the toxic side effects of anti-HIV drug therapy, drug compliance, emergence of drug-resistant viruses, expensive costs, and the fact that widespread publicity of this prophylactic effect may lead to neglect of the most effective behavioral prevention awareness and behavior change, and even less focus on safe sex practices.
About circumcision and AIDS The penile foreskin is rich in macrophages (langerhans cells) that can be attacked by HIV, which are the target cells for HIV transmission and infection, and evidence from Africa suggests that circumcision can reduce HIV infection rates by up to 65%.
Circumcision is a risk factor for a variety of systemic and local diseases, including glans circumcision, urinary tract infections, HIV, HPV, chlamydia, penile cancer, and cervical cancer in sexual partners, and circumcision is beneficial for health and lifelong benefits.
The Centers for Disease Control and Prevention (CDC) defines occupational exposure with risk of HIV infection as contamination of a patient’s blood or body fluids with HIV transmission, including semen, vaginal secretions, cerebrospinal fluid, synovial membranes, pleura, peritoneum, pericardial fluid, amniotic fluid, and laboratory samples containing HIV, through the broken skin of medical personnel. For example, when you are pricked by a needle or cut by a sharp instrument, or when you come in contact with skin and mucous membranes of medical personnel with chaps, abrasions or suffering from dermatitis, or when your skin or mucous membranes are exposed to blood, body fluids and extensive areas of patients for a long time. There are few domestic reports of health workers exposed to HIV/AIDS, and even foreign reports and studies are mostly from health workers. The fact that two police officers were among the seven people counted in this study illustrates the risk of exposure and the possibility of infection in other occupations as well. The chance of infection after exposure in healthy workers is very low and depends on the following three aspects: post-exposure prophylaxis, immunity of the exposed person, and ineffectiveness of the exposure. However, how to determine the post-exposure situation, how to treat after exposure and how to reduce the risk of post-exposure is worth discussing.
Post-exposure treatment includes: wound treatment, risk assessment, drug prophylaxis and drug side effects, and time for follow-up monitoring.
1, post-exposure risk assessment According to foreign research data, the post-exposure risk is in the following order: skin intact < skin and mucous membrane integrity compromised, short exposure time, less blood exposure < skin and mucous membrane integrity compromised after exposure, long exposure time, more blood exposure or wounded by solid needle < wounded by hollow needle, deep wound, wound with visible bleeding, or needle had penetrated the patient's artery or vein. The patient's status is also taken into account to determine how great the risk is from the patient. If the patient is asymptomatic or has a high CD+4 cell count, the risk is relatively low. If the patient is in a progressive phase, or has a primary infection, or a high viral load, or a low CD+4 cell count, the risk is relatively high. Some sources report that the latter risk is 100 to 1000 times greater than the former. Data from a study showed that a total of 6135 healthy workers were stabbed by HIV-contaminated needles, of which 20 were infected by HIV, with an HIV infection rate of 0.33%. 1143 were exposed to mucosal surfaces, of which 1 was infected by HIV, with an infection rate of 0.09%. 2712 were exposed to skin, with no infection occurring in 1 case. (2) Treatment of post-exposure wounds Stimulate bleeding: If there is a wound, squeeze it gently, squeeze out as much blood as possible, and rinse with soapy water or water. (2) Disinfection of the injured area: the wound should be disinfected by applying disinfectant solution (such as 75% alcohol, 0.2% sodium hypochlorite, 0.2% to 0.5% peroxyhexanoic acid, 0.5% iodophor, etc.) soaking or smearing, and dressing the wound. Exposed mucous membrane should be rinsed off with water or saline. 3. Post-exposure drug prophylaxis Azidothymidine is the only drug that has been shown to reduce the occurrence of HIV infection after needle-stick injuries. Double Tide is a two-combination antiviral drug available in the domestic market produced by Glaxo, namely AZT+3TC, which has stronger antiviral activity, and 3TC is well tolerated and generally does not increase the toxic side effects of prophylaxis, so this combination is more reasonable, namely AZT 300mg twice a day and 3TC 150mg twice a day. Most authorities recommend a regimen of at least two drugs for drug prophylaxis. If the injury is significant and there is a higher risk, AZT + 3TC + 1 protease inhibitor should be used. Reverse transcriptase inhibitors in combination with protease inhibitors have more potent antiviral activity and prevent treatment failure due to resistance to 3TC or/and AZT by viruses in the source of contamination. The non-nucleoside reverse transcriptase inhibitor, nevi rapine, is also a used prophylactic agent with the advantage of being better tolerated, the main disadvantage being the high incidence of rash (18%) and the risk of Stevens Johnson syndrome. In China, because there are fewer sources of drugs available, in emergency situations, if there are difficulties, whatever is available can be taken first as soon as possible. The sooner you start preventive medication for occupational exposure, the better, preferably within 1 to 2 hours of the accident. Animal studies have shown that prophylaxis delayed until 24 to 36 hours later will have no preventive effect. However, the CDC still recommends that prophylaxis should still be administered 1 to 2 weeks after a high-risk occupational exposure. There is no accepted course of treatment, which is generally 4 weeks. Women of childbearing age should use contraception or terminate pregnancy while using AZT as a prophylactic agent. Some animal studies have shown that AZT can increase the risk of cancer in pregnant mice. Although there is no similar evidence of toxicity in humans. 3TC and Indinavir were administered during pregnancy, their safety reports are scarce. Because seroconversion generally occurs at 6 to 12 weeks after HIV infection, up to 6 months. Post-exposure testing (0 weeks) is primarily to rule out whether infection has occurred prior to exposure, so anti-HIV antibody monitoring should be performed at 0 weeks, 6 weeks, 12 weeks, and 6 months after the onset of exposure. However, HIV serologic conversion is known to have occurred >6 months after occupational exposure in 3 health workers in the United States, so the need for 1-year follow-up remains debated. P24 antigen and viral load can be tested if necessary, and should also include monitoring for adverse effects of drugs used, such as blood work, liver and kidney function.
Although, there are effective drugs to reduce the incidence of HIV/AIDS after exposure, there are reports of failure, and the psychological stress and mental burden after exposure cannot be solved by any drugs, so the most important thing is to prevent exposure. According to foreign data, the most infected people after exposure are nurses and laboratory workers, while doctors are rare, although they also have many technical operations and surgeries. So some advocate that education of health workers is the most effective prevention strategy to reduce the risk of occupational exposure and infection, including the ways of disease transmission, the degree of risk after exposure, and the rate of infection. Moreover, health workers should strictly implement the aseptic operation system in their work, and they should wear a hat and mask for general check-ups, and rubber gloves if their hands are damaged, and protective glasses and double rubber gloves when there are invasive operations, such as bone puncture, lumbar puncture and lymph node biopsy. Try to avoid direct contact when handling their used items such as syringes, infusion sets, and sending biopsy specimens for examination. In short, by being vigilant, the danger will be minimized.