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The US Public Health Service (USPHS)
has issued updated guidelines for managing healthcare workers’ occupational
exposure to HIV. Under these guidelines, healthcare workers exposed to HIV
should begin treatment immediately with four weeks of post-exposure prophylaxis
(PEP) with three antiretroviral drugs. This is a change from the 2005
recommendations, which suggested that the number of drugs should be based on
assessment of the risk of infection. According to CDC’s David Kuhar, MD, and
colleagues, earlier recommendations presented a challenge because of difficulty
determining risk levels.
USPHS left in place some of the old
guidelines, including PEP where there is occupational exposure; investigation
of HIV status of the source to determine whether PEP is necessary; immediate
initiation of treatment that should last four weeks; consultation with HIV
experts, particularly in complicated cases such as exposure of pregnant women,
suspicion of HIV drug resistance in the source, or serious underlying illness
of the exposed worker; and close follow-up with initial counseling, baseline,
and follow-up testing and monitoring 72 hours after exposure.
The new recommendations shortened
follow-up testing from six months to four months with the use of a fourth-generation
test, as newer tests detect the HIV p24 antigen and antibodies to the virus and
are more reliable than previous tests. It also recommended a preferred initial
regimen—a combination of tenofovir and emtricitabine with raltegravir—because
that regimen has a convenient dosing schedule and favorable side effects.
However, those undergoing treatment still require expert consultation to adapt
the treatment to the exposed individual.
The full report, “Updated US Public
Health Service Guidelines for the Management of Occupational Exposures to Human
Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis,” was
published online in the journal Infection Control and Hospital Epidemiology
(2013; doi: 10.1086/672271).
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus.
To learn more about The Friends of
AIDS Foundation, please visit: http://www.friendsofaids.org.
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