HIV post-exposure prophylaxis: Difference between revisions

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===Substantial Risk===
===Substantial Risk===
*CDC preferred regimen:
*CDC preferred regimen:<ref>Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis.  August 6, 2013. http://www.jstor.org/stable/10.1086/672271 DOI: 10.1086/672271 </ref>
**Raltegravir (isentress) 400 mg PO twice daily, plus
**Raltegravir (isentress) 400 mg PO twice daily, plus
**Truvada (tenofovir 300 mg + emtricitabine 200 mg) 1 PO once daily
**Truvada (tenofovir 300 mg + emtricitabine 200 mg) 1 PO once daily


;CDC no longer recommends that the severity of exposure be used to determine the number of drugs to be offered in an HIV PEP regimen, and a regimen containing 3 (or more) antiretroviral drugs is now recommended routinely for all occupational exposures to HIV. <ref>Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis.  August 6, 2013. http://www.jstor.org/stable/10.1086/672271 DOI: 10.1086/672271 </ref>
;CDC no longer recommends that the severity of exposure be used to determine the number of drugs to be offered and a regimen containing 3 antiretroviral drugs is now recommended routinely for all occupational exposures.<ref>Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis.  August 6, 2013. http://www.jstor.org/stable/10.1086/672271 DOI: 10.1086/672271 </ref>


===National Clinician's Post-Exposure Prophylaxis Hotline===
===National Clinician's Post-Exposure Prophylaxis Hotline===

Revision as of 05:22, 15 January 2015

Background

  • Also known as Post-Exposure Prophylaxis (PEP)
  • ~79% transmission reduction
  • Initiate ASAP (goal = 1-2 hours)
  • >36 hours: normally deferred, unless particularly high risk
  • Common side-effects = constitutional, gastrointestinal

Exposure Transmission Risk

Exposure^
 Risk
Percutaneous 0.3%
Mucocutaneous 0.09%
Needle-sharing injection drug 0.7%
Receptive anal intercourse 0.5%
Receptive penile-vaginal intercourse 0.1%
Insertive anal intercourse 0.07%
Insertive penile-vaginal intercourse 0.05%
Receptive oral (male) intercourse 0.01%
Insertive oral (male) intercourse 0.005%

^assumes no condom use

High Risk Exposures

Source

  1. Symptomatic HIV/AIDS
  2. Acute seroconversion
  3. High viral load

Exposure

  1. Deep injuries
  2. Visible blood on device
  3. Injuries sustained placing a catheter in a vein/artery

Workup (Before Giving)

  • CBC
  • C7
  • LFTs
  • Pregnancy test

Management

Negligible Risk

  • NOT recommended

Substantial Risk

  • CDC preferred regimen:[1]
    • Raltegravir (isentress) 400 mg PO twice daily, plus
    • Truvada (tenofovir 300 mg + emtricitabine 200 mg) 1 PO once daily
CDC no longer recommends that the severity of exposure be used to determine the number of drugs to be offered and a regimen containing 3 antiretroviral drugs is now recommended routinely for all occupational exposures.[2]

National Clinician's Post-Exposure Prophylaxis Hotline

  • 1-888-448-4911, call for expert advice

See Also

Source

  1. ↑ Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. August 6, 2013. http://www.jstor.org/stable/10.1086/672271 DOI: 10.1086/672271
  2. ↑ Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. August 6, 2013. http://www.jstor.org/stable/10.1086/672271 DOI: 10.1086/672271
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