HIV PEP – Occupational

HIV Occupational Post-Exposure Prophylaxis Regimen:

 

Raltegravir 400mg PO Twice Daily

(Isentress®; RAL)

Plus

Truvada™,1 PO Once Daily

[Tenofovir DF (Viread®; TDF) 300mg + emtricitabine (Emtriva™; FTC) 200mg]

CDC Recommended approach:

1) Evaluate exposure:
  • Exposures posing risk of infection transmission :
    • Percutaneous injury
    • Mucous membrane exposure
    • Non-intact skin exposure
    • Bites resulting in blood exposure to either person 
      involved
  • Substances posing risk of infection transmission:
    • Blood
    • Fluids containing visible blood
    • Potentially infectious fluids (semen; vaginal secretions; and cerebrospinal, synovial, pleural, peritoneal, pericardial, and
      amniotic fluids) or tissue
    • Concentrated virus
2) Determine infection status of source patient:  (do not test used needles)
  • HBVsAg
  • HCV antibody
  • HIV antibody
3) Determine susceptibility of exposed person:
  • HB vaccine status
  • HBV immune status (anti-HBs titer) if vaccine response unknown
  • Anti-HCV and ALT
  • HIV antibody
4) If at risk, offer PEP:
  • Initiate PEP within hours of exposure
  • Offer pregnancy testing to all women of childbearing age not known to be pregnant; PEP can be given to pregnant women
  • Seek expert consultation if viral resistance suspected
  • Administer PEP for 4 weeks if tolerated
5) Follow up testing:
  • Evaluate exposed persons taking PEP within 72 hours after exposure and monitor for drug toxicity for at least 2 weeks
  • Perform HIV-antibody testing for at least 6 months postexposure (e.g., at baseline, 6 weeks, 3 months, and 6 months)
  • Perform HIV antibody testing for illness compatible with an acute retroviral syndrome
  • Advise exposed persons to use precautions to prevent secondary transmission during the follow-up period
(CDC) Situations for Which Expert Consultation for Human Immunodeficiency Virus (HIV) Postexposure Prophylaxis (PEP) is Recommended:
  • Delayed (i.e., later than 72 hours) exposure report
    • Interval after which benefits from PEP are undefined
  • Unknown source (e.g., needle in sharps disposal container or laundry)
    • Use oPEP to be decided on a case-by-case basis
    • Consider severity of exposure and epidemiologic likelihood of HIV exposure
    • Do not test needles or other sharp instruments for HIV
  • Known or suspected pregnancy in the exposed person
    • Provision of PEP should not be delayed while awaiting expert consultation
  • Breastfeeding in the exposed person
    • Provision of PEP should not be delayed while awaiting expert consultation
  • Known or suspected resistance of the source virus to antiretroviral agents
    • If source person’s virus is known or suspected to be resistant to one or more of the drugs considered for PEP, selection of drugs to which the source person’s virus is unlikely to be resistant recommended
    • Do not delay initiation of PEP while awaiting any results of resistance testing of the source person’s virus
  • Toxicity of the initial PEP regimen
    • Symptoms (e.g. GI symptoms and others) often manageable without changing PEP regimen by prescribing antimotility or antiemetic agents
    • Counseling and support for management of side effects is very important as symptoms are often exacerbated by anxiety.
  • Serious medical illness in the exposed person
    • Significant underlying illness (e.g. renal disease) or an exposed provider already taking multiple medications may increase the risk of drug toxicity and drug-drug interactions

Expert consultation can be made with local experts or by calling the US National Clinicians’ Post-Exposure Prophylaxis Hotline (PEPline) at 888-448-4911.

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