Ear, Nose and Throat - U.S.A.  (ENT USA) Healthcare Worker and AIDS
AIDS - HIV Exposure Prophylaxis and the Healthcare Worker
Acquired Immune Deficiency Syndrome (AIDS)
Post HIV Exposure Prevention (Prophylaxis)
  
  
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(Note:  This discussion is only to serve as a guideline and portions may become out of date.  Always consult a medical professional for up-to-date information and treatment recommendations).   

PEP stands for post exposure prophylaxis and is recommended for workers who may have been exposed to the Human Immunodeficiency Virus (HIV).  Overall the risk of infection is approximately 0.3%, but varies by the severity of exposure.  The risk after exposure to the mucosa is 0.09%  ( Note: There is not an appreciable risk from exposure to intact skin ).
  View MMRW 2005 Report   View MMWR 2001 Report 

The levels of HIV are reduced  by 90% to 95% after 9 hours of drying in the environment.  (Resnick, JAMA 1986)  View Abstract

There are three factors which must be considered:

  •    When Should PEP Be Given: 

PEP can be hard to tolerate causing nausea in up to 57%, fatigue and malaise in up to 38% and headaches in up to 18% of recipients.    Wang, et. al, (2000)  View Abstract          
  
PEP should be strongly considered and probably given, if:

  1. Can be administered in less then 72 hours.
  2. The source is known to be positive for HIV.
  3. Deep cut or penetration.
  4. Exposed to a large amount of blood.
  5. Hollow needle exposure.

Risks of toxicity need to be weighed against the risks of exposure.  High-risk exposures are those with a large hollow bore needle, deep puncture, visible blood on the needle or knife.   Blood splashed in the eyes.   Saliva, ear wax, tears, vomitus, feces, nasal secretions, and urine are not considered infectious unless mixed with blood.   Amniotic fluid, cerebrospinal fluid exudates and serosal fluids may pose a risk.  (MMWR 2005)  http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm 
The use of gloves decreases the volume of exposure by 50%.  

In general, (always consult your infectious disease physician for up to date recommendations) PEP is not indicated if the source is unknown or the HIV status is unknown and the exposure is less severe.  

If the source is found to be HIV negative after initiating PEP, PEP should be stopped. 

  •   Timing of the Prophylaxis: 

To be effective PEP should be given within the first 72 hrs.  Within this time frame, PEP is nearly 100% effective.  

The spread of SIV (simian immunodeficiency virus) within the body occurs within days (Spira, 1996  View Abstract)

At 24 hours SIV is detected in the vagina.
At 48 hours SIV is detected in the regional lymph nodes.
At 5 days SIV is detected in the bloodstream.

Animal studies indicate that treatment should start within 24 hours. (Tsai, 1995 View Abstract

Protection from Infection if is PEP given within 24 hours. (Tsai, 1995 View Abstract) :

Received within 24 hrs   -  100%
Received within 48 hrs   -   50%
Received within 72 hrs   -   25%

  •    Length of Time Drugs are given: 

    At least two drugs are give because of HIV resistance to medications.  Three or more drug regimes may be recommended for some high-risk exposures.  Treatment should last a total of 4 weeks .  

    If prophylaxis is unsuccessful, seroconversion in the exposed worker should take place before 6 months and usually occurs within four weeks. 

    Animal studies indicate the length of treatment should be for 28 days (Tsai, 1995 View Abstract

    Protection from Infection if PEP given within (Tsai, 1995 View Abstract) :

    28 days   -  100%
    10 days   -   50%
    3 days     -   0%

   

  
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