Postexposure Prophylaxis (PEP)

Definitions:

• Antirertoviral (ART) medications include agents FDA approved to treat HIV infection from 6 classes of drugs
  
  • Nucleoside and nucleotide reverse-transcriptase inhibitors (NRTIs)
  • Nonnucleoside reverse-transcriptase inhibitors (NNRTIs)
  • Protease inhibitors (PIs)
  • Fusion inhibitor (FI)
  • integrase strand transfer inhibitor (INSTI)
  • Entry inhibitor (CCR5) antagonist
• HIV - Human Immunodeficiency virus
• Occupational exposure - employment related percutaneous injury (eg, a needlestick or cut with a sharp object) or contact of mucous membrane or non- intact skin (eg, exposed skin that is chapped, abraded, or afflicted with dermatitis) with blood, tissue, or other body fluids that are potentially infectious.
• PEP - Postexposure prophylaxis is the administration of antiretroviral medications, as soon as possible and no longer than 72 hours after an occupational exposure, with the intent to prevent systemic HIV infection.
• PEP Regimens - include at least three ARTs selected to maximize patient tolerance; subsequent antiretroviral resistance testing of the exposure source may require alternative medication selections.

A Summary of the 2013 U.S. PHS Guidelines for the Management of Occupational Exposures to HIV:

• PEP is recommended for the management of occupational exposure to blood and/or other body fluids that might contain human immunodeficiency virus (HIV).
• Start PEP medication regimens as soon as possible after occupational exposure to HIV and continue them for a 4-week duration.
• PEP medication regimens should contain 3 (or more) antiretroviral drugs for all occupational exposures to HIV.
• Determine the HIV status of the exposure source person to guide need for HIV PEP, if possible.
• Expert consultation is recommended for any HIV occupational exposure:
  • Expert consultation can be made with local experts or by calling the National Clinicians’ Post-Exposure Prophylaxis Hotline (PEPline) at 888-448-4911.
  • Counseling, baseline and follow-up HIV testing, and monitoring for PEP drug toxicity within 72hrs.
    • HIV exposed healthcare personal tolerate antiviral treatment less well than HIV+ patients, side effects are cited as major reason for non-completion of PEP regimens.
• If a 4th generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed worker, HIV testing may be concluded at 4 months after exposure. Older testing platforms may be concluced 6 months after exposure.
• Exposure to a source patient with an undetectable serum viral load does not eliminate the possibility of HIV transmission or the need for PEP and follow-up testing.

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