HealthDay News — The U.S. Public Health Service has updated management and prophylaxis recommendations for healthcare providers with occupational exposure to HIV.
The revised guidelines specify those exposed to HIV should immediately start four weeks of post-exposure prophylaxis (PEP) with three antiretroviral drugs, instead of basing the number of PEP drugs prescribed on risk for infection as the previous 2005 recommendations stated.
The earlier recommendations were challenging to apply in practice, because it is often difficult to determine the level of risk for infection in any given incident, David T. Kuhar, MD, of the CDC, and colleagues reported in Infection Control and Hospital Epidemiology.
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Other changes include shortening the recommended period for follow-up HIV testing from six months to four, if newer fourth-generation tests are used because these detect both the HIV p24 antigen and antibodies to the virus, and are considered more reliable than earlier tests. If a newer testing platform is not available, follow-up HIV testing is generally concluded six months after exposure.
When occupational exposures to blood and/or other bodily fluids that might contain HIV occur — ranging from needlesticks to contact between a cut and potentially infectious fluids — post-exposure prophylaxis (PEP) is recommended, the guidelines state.
If possible, the HIV status of the exposure source patient should be determined. After exposure to HIV, PEP medication regimens should be started as soon as possible, and should be continued for four weeks.
For all occupational exposures to HIV, PEP medication regimens should contain three or more antiretroviral drugs.The preferred initial regimen consists of a combination of tenofovir and emtricitabine (Truvada) with raltegravir (Isentress) due to ” a favorable side effect profile as well as a convenient dosing schedule,” the researchers wrote.
However, expert consultation should be undertaken to tailor regimens to exposed individuals, particularly in cases involving an exposed person who is pregnant, if HIV drug resistance is suspected in the source contact, if the the initial regimen is poorly tolerated or toxic or if the exposed individual has a serious underlying illness, such as renal disease.
Exposed personnel should be provided with close follow-up, which should begin within 72 hours of exposure and should include counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity.
HIV testing may be concluded four months after exposure if a newer generation combination HIV p24 antigen-HIV antibody test is used. Follow-up HIV testing is generally concluded six months after exposure if a newer testing platform is not available.
“As new antiretroviral agents for treatment of HIV infection and additional information concerning early HIV infection and prevention of HIV transmission become available, the interagency Public Health Service working group will assess the need to update these guidelines,” the researchers wrote.
