Postexposure Prophylaxis
(The contents of this page are excepted from Morbidity and Mortality Weekly Report, September 30, 2005 / Vol. 54 / No. RR-9)
The U.S. Public Health Service (PHS) has revised its recommendations for postexposure prophylaxis (PEP) following occupational exposure to HIV. An exposure occurs when HIV is assumed to have been introduced into an individual by percutaneous injury, contact with mucous membranes or nonintact skin.
The risk of transmission of HIV varies depending upon the character of the exposure and the viral load of the infectious material. For example, the average risk of transmission of HIV following percutaneous exposure to HIV infected blood is approximately 0.3%. Seroconversion after mucous membrane exposure to infected blood is about 0.09%.
Appropriate postexposure management will consider the risk of transmission relative to the risk inherent in PEP treatment. Anecdotal evidence indicates that healthcare personnel taking HIV PEP tolerated the treatment less well than HIV infected persons taking antiretrovirals. Side effects were frequently reported by healthcare personnel taking PEP antiretrovirals. As many as 24% of healthcare worker who received PEP in two studies prematurely discontinued treatment due to side effects. Use of rapid HIV testing to evaluate the source for HIV can reduce PEP use and decrease anxiety.
Recommended HIV postexposure prophylaxis (PEP) for percutaneous injuries |
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Infection status of source |
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Exposure |
HIV+class 1 Asymptomatic "Low viral load" RNA1500 <copies/mL |
HIV+class 2 "high viral load" , symptomatic |
Source HIV status unknown Source refuses testing |
Source unknown Needle in sharps container |
HIV negative |
| Less severe (Solid needle, superficial injury) |
Recommended 2-drug PEP |
Recommended >3 drug PEP |
PEP optional, consider basic 2-drug PEP if source has risk factors | PEP optional, consider basic 2-drug PEP if source is likely HIV+ | No PEP or discontinue PEP |
More severe |
Recommend 3-drug PEP |
Recommended >3 drug PEP |
PEP optional, consider basic 2-drug PEP if source has risk factors | PEP optional, consider basic 2-drug PEP if source is likely HIV+ | No PEP or discontinue PEP |
Recommended HIV postexposure prophylaxis (PEP) for percutaneous injuries Mucous membrane and nonintact skin exposure |
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Infection status of source |
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Exposure |
HIV+class 1 Asymptomatic "Low viral load" RNA1500 <copies/mL |
HIV+class 2 "high viral load" , symptomatic |
Source HIV status unknown Source refuses testing |
Source unknown Splash of improperly disposed blood |
HIV negative |
Small volume (few drops) |
Optional 2-drug PEP | Recommended 2-drug PEP |
PEP optional | PEP optional | No PEP or discontinue PEP |
Large volume (Major blood splash) |
Recommended 2-drug PEP |
Recommended >3 drug PEP |
PEP optional, consider basic 2-drug PEP, if source has risk factors | PEP optional, consider basic 2-drug PEP if source is likely HIV+ | No PEP or discontinue PEP |
| Chart adapted from "Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis" (2005) | |||||
PEP should begin preferably within hours rather than days after exposure. Consultation with antiretroviral therapy and HIV transmission expert is strongly recommended if: