POSTEXPOSURE PROPHYLAXIS OF HIV INFECTION

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POST-EXPOSURE PROPHYLAXIS OF HIV INFECTION

• CDC RECOMMENDATIONS
• MMWR May 15, 1998, Vol 47, No RR-7

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What is the risk of HIV infection?

• Occupational
• Percutaneous 0.3
• Mucous membrane 0.09
• Sexual transmission 0.018 to 3
• Mother to child 25
• Infected blood products 95
• Antiviral therapy 1998 3 (Suppl 4) 45-47

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Who is at Risk for Occupational Exposure?

• All HCWs who come in contact with blood or
  bloody fluids in hospitals or laboratories
• Nurses, laboratory workers, doctors, residents,
  paramedics, emergency doctors, medical students
• HCWs Health Care Workers

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Body Fluids Which Can Transmit HIV

• Blood, bloody fluids
• Potentially infectious semen, vaginal
  secretions, CSF, pleural, peritoneal,
  pericardial, amniotic fluids or tissue
• No risk saliva, tears, sweat, non-bloody urine
  or faeces

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Factors Influencing Risk for HCWs

• Depth of injury
• Device visibly contaminated with blood
• Procedure involving a needle placed in artery or
  vein
• Type of needle (hollow bore or solid)
• Size of needle
• Source patients viral load
• Amount of blood
• Duration of exposure
• Immune status of HCW

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How To Reduce Risk?

• Number of procedures
• Double gloves
• Gowns, facemasks, goggles. Care during procedures
  such as endoscopy, ENT surgery, others where
  splattering of blood is anticipated
• Use of impervious needle-disposal containers
• Transport of samples in sealed containers

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Treatment Of Occupational ExposureImmediate
Measures

• Use of soap and water to wash any wound or skin
• Flush exposed mucous membrane with water
• Open wounds - irrigate with sterile saline or
  disinfectant solution
• Eyes should be irrigated with clean water, saline
  or sterile eye irrigants
• Report to the concerned authority
• Counseling
• Antiretroviral therapy

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Post Exposure Prophylaxis for HCWs
Source material blood, bloody fluid
Type of exposure
Intact Skin
Mucous membrane or broken skin
Percutaneous exposure
(no PEP needed)
Volume
Severity
Small
More severe
Large
Less severe
(few drops, short duration)
(deep, large bore hollow needle)
(several drops, long duration)
(solid needle, superficial scratch)
Negligible risk.Consider basic regimen if source
has high HIV load or unknown
Basic PEP regimen if source has high HIV load
Expanded PEP regimen
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Regimens For Post Exposure Prophylaxis

• Type Drugs Regimen
• Basic Zidovudine 600 mg/day
• (28 days) (Zidovir) (300 mg bid, 200 mg tid or
  100 mg 4 hourly)
• Plus
• Lamivudine 150 mg bid
• (Lamivir)
• Expanded As above
• (28 days) plus
• Indinavir (Crixivan) 800 mg 8 hourly
• or
• Nelfinavir (Viracept) 750 mg tid