0071643192.pdf

INFECTIOUS DISEASE

■ Associated with 79% reduction in transmission

■ Initiate ASAP (goal =1–2 hours).

■ >36 hours: Normally deferred, unless particularly high risk

■ Common side effects =constitutional, gastrointestinal.

■ See Table 8.8 for general guidelines.

■ CDC website lists specific regimens.

Nonoccupational Exposure

■ Sexual-assault victims, sexual partners, or needle-sharing partners of sources
with possible transmission
■ Accounts for ~80% of all HIV PEP given

SYMPTOMS/EXAM

■ For sexual assault, keep records of detailed exam.
■ Frequently performed by specialized professional
■ See Table 8.6 for HIV transmission rates.

TREATMENT

■ Tetanus immunization
■ Pregnancy prophylaxis if appropriate
■ Initiate <72 hours
■ Check pregnancy test, then
■ Plan B or Ovral (several suggested regimens)
■ If considering prophylaxis, CDC recommends baseline HIV, CBC,
BUN/creatinine, LFTs, Hepatitis B and C serology of exposed patient.

TABLE 8.7. Risk Stratification for HIV Transmission

TYPE LOWRISK HIGHRISK

Source Asymptomatic HIV Symptomatic HIV/AIDS

Viral load <1500 copies/mL Acute seroconversion

High viral load

Exposure Superficial Deep injuries

Solid needle Visible blood on device

Contact with intact skin =no risk. Injuries sustained placing a catheter

in a vein/artery

TABLE 8.8. Occupational HIV Postexposure Treatment Guidelines

REGIMEN APPLICATION TREATMENTa

Basic Exposures for which there is a 4-wk, two-drug regimen (normally

recognized transmission risk zidovudine and lamivudine)

Expanded High-risk exposures Basic regimen +protease inhibitor

(eg, indinavir or nelfinavir)

aIf source has a known resistant HIV strain, consult specialist for specifically tailored regimen.