OBJECTIVE: To investigates how the use of HIV-1 resistance tests influences physician decision-making. METHODS: Ten experienced reference physicians from the Brazilian Network for Drug Resistance each received ten patients' case histories. The selected patients had experienced at least two virological failures. First, reference physicians were asked to empirically select a new regimen for each patient. Second, after genotype report (ViroSeq 2.6) was provided, and physicians were again asked to select a new regimen considering this additional information. Finally, they were asked to select a regimen after receiving a virtual phenotype result (vircoTYPE 3.9.00). RESULTS: In 79% of the cases, physicians changed their empirical choice of regimen after receiving the genotype report, resulting in an increase in the mean number of active drugs from 1.8 to 2.2 (p = 0.0003), while the average number of drugs/regimen remained at 4.0. After receipt of the virtual phenotype report, additional changes were made in 75% of the patient cases, resulting in an increase in the number of active drugs to 2.8 (p < 0.0001), while the average number of drugs/regimen remained at 4.0. After receipt of the genotype report, 48% of the changes were in NRTIs, 29% were in NNRTIs and 60% were in PIs; after consideration of the virtual phenotype, 61%, 10% and 49% of the changes, respectively, were in these categories of drugs. Fourteen percent of the physicians rated the genotype report as "extremely useful", whereas 34% rated the subsequent virtual phenotype report as "extremely useful" (p = 0.0003). CONCLUSIONS: Resistance testing has a significant impact on physicians' choices of antiretroviral salvage therapies, and it promotes the selection of more active drugs

A possibilidade de aquisição do vírus de imunodeficiência humana (HIV) por profissionais de saúde tornou mais preocupante a questão dos riscos ocupacionais. As precauções universais (PU) surgiram como tentativa de aumentar a segurança do profissional de saúde. No entanto, existe certa resistência por parte dos profissionais de saúde em adotar as medidas de proteção. Os objetivos deste estudo são: 1. obter um indicador da adesão da equipe de enfermagem de um hospital geral de São Paulo às precauções universais, 2. identificar a percepção dos riscos e os conhecimentos que os profissionais possuem sobre as PU; e 3. apresentar e discutir hipóteses explicativas do comportamento de não-adesão.

Problems regarding to occupational risk became more apprehensive with the possibility of occupational exposure to HIV by healthcare workers. Universal precautions (UP) emerges as an attempt to increase security of healthcare workers. Nonetheless, the compliance with universal precautions was found to be considerably less than optimal. The purpose of the present paper is: 1. to measure the compliance with universal precautions at a general hospital in São Paulo; 2. to identify the risk perception and Knowledge about UP of nursing staff, and 3. to discuss alternative hypothesis to explain noncompliance.

Problems regarding to occupational risk became more apprehensive with the possibility of occupational exposure to HIV by healthcare workers. Universal precautions (UP) emerges as an attempt to increase security of healthcare workers. Nonetheless, the compliance with universal precautions was found to be considerably less than optimal. The purpose of the present paper is: 1. to measure the compliance with universal precautions at a general hospital in São Paulo; 2. to identify the risk perception and Knowledge about UP of nursing staff, and 3. to discuss alternative hypothesis to explain noncompliance.

A possibilidade de aquisição do vírus de imunodeficiência humana (HIV) por profissionais de saúde tornou mais preocupante a questão dos riscos ocupacionais. As precauções universais (PU) surgiram como tentativa de aumentar a segurança do profissional de saúde. No entanto, existe certa resistência por parte dos profissionais de saúde em adotar as medidas de proteção. Os objetivos deste estudo são: 1. obter um indicador da adesão da equipe de enfermagem de um hospital geral de São Paulo às precauções universais, 2. identificar a percepção dos riscos e os conhecimentos que os profissionais possuem sobre as PU; e 3. apresentar e discutir hipóteses explicativas do comportamento de não-adesão.