Preventing
exposures to blood and body fluids (i.e., primary prevention) is the most important
strategy for preventing occupationally acquired human immunodeficiency virus
(HIV) infection. Healthcare personnel
(HCP) should adhere to the principle of Standard Precautions, including
consistent use of appropriate work practices, work practice controls, and
personnel protective equipment (PPE).
Healthcare
personnel should be aware of the recently published U.S. Public Health Service
Guidelines for the Management of Occupational Exposures to Human Immunodeficiency
Virus and Recommendations for Postexposure Prophylaxis [PEP] (http://www.jstor.org/stable/full/10.1086/672271). This report continues to emphasize the
following:
- Primary prevention of occupational exposures
- Prompt management of occupational exposures, and, if indicated, initiation of PEP
- Selection of PEP regimens that have the fewest side effects and that are best tolerated by prophylaxis recipients
- Anticipating and preemptively treating side effects commonly associated with taking antiretroviral drugs
- Attention to potential interactions involving both drugs that could be included in HIV PEP regimens and medications that PEP recipients might be taking
- Consultation with experts on PEP management strategies
- HIV testing of source patients (without delaying PEP initiation in the exposed provider) using methods that produce rapid results
- Counseling and follow-up of the exposed HCP
Recommendations
included in this report may be summarized as follows:
- PEP is recommended when occupational exposures to HIV occur
- The HIV status of the exposure source patient should be determined, if possible, to guide the need for PEP
- PEP medication regimens should be started as soon as possible after occupational exposure to HIV, and they should be continued for a 4-week duration
- New recommendation—PEP medication regimens should contain 3 (or more) antiretroviral drugs (listed in paper) for all occupational exposures to HIV
- Expert consultation is recommended for any occupational exposures to HIV and at a minimum for situations described in Box 1
- Close follow-up for exposed personnel (Box 2) should be provided that includes counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity; follow-up appointments should begin within 72 hours of an HIV exposure
- New recommendation—if a newer fourth-generation combination HIV p24 antigen–HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded 4 months after exposure (Box 2); if a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after an HIV exposure.
