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A 65-year-old man with weight loss, a 65-year-old Surinam woman with dyspnoea, and a 55-year-old lesbian woman suffering from painful joints, weight loss and diarrhoea were eventually diagnosed as being infected with HIV. At the time of diagnosis, all three patients had CD4 counts below 100 cells x 10(6)/l and had presented with aids defining symptoms. In the Netherlands, an estimated 40% of people infected with HIV do not know about their HIV status. Earlier recognition would reduce morbidity and mortality and furthermore, reduce transmission of the virus. For this reason we advocate routine HIV testing for all persons belonging to a population with an HIV prevalence above 0.2% but also for all patients presenting with unresolved chronic complaints, irrespective of HIV risk factors.

A 46-year-old man and a 58-year-old man, both known for several years with HIV infection, were admitted for operations due to aortic valve insufficiency (aortic valve replacement) and posttraumatic coxarthrosis (total hip replacement) respectively. In accordance with the protocol, preoperative viral infections (HIV, hepatitis B and C) were inventoried, the HIV viral load was lowered medicinally and the operation team informed. During each operation a consultant was present in the operating theatre to provide advice in the case of a needlestick or cut accident. No accidents occurred. Both patients were discharged to home in a good condition.

To evaluate a protocol for hospital staff aimed at reducing their risk of exposure to blood-transmitted infections.Prospective.In August 1997 a protocol was introduced to the Onze Lieve Vrouwe Gasthuis Hospital in Amsterdam, with procedures to be followed after percutaneous or mucocutaneous blood contact in which there was a chance of transmission of hepatitis B (HBV) or C (HCV), as well as guidelines for the prescription of post-exposure prophylaxis (PEP) after accidents with an HIV risk. In the period 1 August 1997-30 June 2001 data were collected from registration forms that reported accidents and the ensuing events.A total of 403 accidents were reported by 138 (34.2%) physicians, 135 (33.5%) ward nurses, 46 (11.4%) operation assistants, 30 (7.4%) co-assistants, 21 (5.2%) analysts and 33 (8.2%) persons with another position. There was a constant increase in the number of reports over the period. The seroprevalence of the source patients was: 6.9% (25/360) HIV, 8.1% (6/74) HBV and 6.3% (23/363) HCV. PEP was prescribed on 46 occasions: 15 times for an HIV positive source and 31 times for what was initially an unknown HIV source. Following the introduction of a rapid HIV test in September 1999, there was a reduction in the number of unnecessary PEP prescriptions from 4 in 1997, 7 in 1998 and 16 in 1999 to 3 in 2000 and 1 in 2001. All 15 persons who were correctly started on a PEP treatment took the medication for a period of 28 days despite many side effects. No seroconversions were established during the follow-up period of 6 months.