View source for HIV post-exposure prophylaxis

==Background==
*Also known as HIV Post-Exposure Prophylaxis (PEP)
*Probability of HIV transmission from a percutaneous needle stick is approximately 0.3% (1 in 300) and 0.09% from mucous membrane exposure.<ref>Marcus R. et al. CDC Cooperative Needlestick Surveillance Group. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med. 1988. 319: 1118–1123.</ref><ref>Bell D.M. Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am J Med. 1997. 102: 9–15.</ref>
*~79% transmission reduction
*Common side-effects = constitutional, gastrointestinal

===Timing and Duration of PEP<ref>Kuhar DT et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):875-92. doi: 10.1086/672271.</ref>===
*Initiate ASAP (goal = <2 hours after exposure)
*Initiate if <72 hours since exposure
*PEP is likely to be less effective when started more than 72 hours after exposure, but the interval after which no benefit is gained from PEP for humans is undefined.
*If initiation is delayed, the likelihood increases that benefits might not outweigh the risks inherent in taking antiretroviral medications.

===CDC recommendations===
From 2013 recommendations <ref>Kuhar DT et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):875-92. doi: 10.1086/672271.</ref>
*PEP is recommended when occupational exposures to HIV occur
*PEP medication regimens should be started as soon as possible after occupational exposure to HIV, and continued for 28 days
*'''New recommendation''' - PEP medication regimens should contain 3 (or more) antiretroviral drugs for all occupational exposures to HIV
*'''New recommendation''' - if a newer fourth-generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded 4 months after exposure; if a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after an HIV exposure.

===National Clinician's Post-Exposure Prophylaxis Hotline===
*1-888-448-4911, call for expert advice

==Evaluation of Transmission Risk==
===Exposure Transmission Risk===
{| class="wikitable"
|-
| '''Exposure^'''<br/>
| '''Risk'''<br/>
|-
| 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'''
*Symptomatic HIV/AIDS
*Acute seroconversion
*High viral load

'''Exposure'''
*Deep injuries
*Visible blood on device
*Injuries sustained placing a catheter in a vein/artery

===Low Risk Exposures===
*Dried blood on an old needle
*Human Bites

==Workup==
===Source-Patient===
*Rapid HIV Test
**HIV status of the exposure source patient should be determined, if possible, to guide need for HIV PEP<ref>Kuhar DT et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):875-92. doi: 10.1086/672271.</ref>''

===Exposed-Patient===
Only if giving PEP (before initiation):
*CBC
*Chem 7
*LFTs
*Pregnancy test

==Management==
===Negligible Risk===
*NOT recommended

===Substantial Risk===
{{HIV post-exposure prophylaxis regimens}}

===Pregnant Patients===
*"Expert consultation should be sought in all cases"<ref>Kuhar D, et al. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. September 2013. 34(9):875-892. DOI: 10.1086/672271. http://www.jstor.org/stable/10.1086/672271</ref>

==Disposition==
*Outpatient, with close follow-up for exposed persons that includes:<ref>Kuhar DT et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):875-92. doi: 10.1086/672271.</ref>'' 
**Counseling
**Baseline and follow-up HIV testing
**Monitoring for drug toxicity
**Follow-up appointments should begin within 72 hours of an HIV exposure

==See Also==
*[[Occupational exposure]]
*[[Sexual assault]]
*[[Hepatitis B]]
*[[HIV testing (in California)]]
*[[Harbor:Occupational exposure]]
**[[Harbor:Occupational exposure (dot-phrases)]]

==External Links==
*Harbor-UCLA Policy: https://wikem.org/wiki/File:Non-occupational_Post-Exposure_Prophylaxis_(nPEP)_for_HIV_Prevention_in_Adults_and_Adolescents_Expected_Practice.pdf
*http://ph.lacounty.gov/dhsp/prep-pep-actionkit.htm
*[https://www.cdc.gov/hiv/risk/pep/index.html CDC: Post-Exposure Prophylaxis]
*http://getprepla.com/

==References==
<references/>

[[Category:ID]]