Medical personnel caring for HIV-infected patients may be at risk for acquiring HIV infection through contact with HIV-infected blood and bloody fluids. This is referred as ‘occupational exposure’ to HIV.
|Type of exposure||Risk|
Blood and bloody fluids are considered infectious. Other potentially infectious materials include semen, vaginal secretions, CSF, pleural, peritoneal, pericardial, amniotic fluids or tissue. Exposure to saliva, tears, sweat, non-bloody urine or faeces is not believed to pose a risk.
Post-exposure prophylaxis (PEP) refers to the treatment of occupational exposures using antiretroviral therapy. The rational is that antiretroviral treatment, which is started immediately after exposure to HIV may prevent HIV infection.
|Basic||Lazid or Synvir||1 tab b.i.d.|
|Expanded||As above plusIndinavir or Nelfinavir or Efavirenz||800 mg 8 hourly or 750 mg t.i.d. or 600 mg at night|
A case-control study conducted by the US Centers for Disease Control (CDC) concluded that the administration of zidovudine prophylaxis to health care workers occupationally exposed to HIV was associated with an 80% reduction in the risk for occupationally acquired HIV infection. Although the efficacy of combination regimens for PEP is unknown, combination drug regimens are currently recommended for PEP.
Side effects of the NRTIs (e.g. zidovudine and lamivudine) have been mainly gastrointestinal (e.g. nausea, vomiting). Malaise, fatigue and headache have also been reported. Some experts consider that stavudine may be substituted for zidovudine as a means of reducing adverse effects, and others consider that zidovudine should not be omitted from any PEP regimen. Efavirenz is associated with neurological side effects but has a lower incidence and severity of rash. Nelfinavir frequently causes diarrhoea. It may accelerate the clearance of certain drugs including oral contraceptives, resulting in reduced contraceptive efficacy. Protease inhibitors have been associated with new onset, and exacerbation, of existing diabetes mellitus.
Adapted from: HIV POST-EXPOSURE PROPHYLAXIS, Guidance from the UK Chief Medical Officers’ Expert Advisory Group on AIDS, February 2004