(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guideline and portions may become out of date.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
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)
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)
PEP should be strongly considered and probably given, if:
- Can be administered in less then 72
- The source is known to be positive for
- Deep cut or penetration.
- Exposed to a large amount of blood.
- 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)
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
The spread of SIV (simian immunodeficiency
virus) within the body occurs within days (Spira, 1996
At 24 hours SIV is detected in the
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
Protection from Infection if is PEP given
within 24 hours.
View Abstract) :
Received within 24 hrs - 100%
Received within 48 hrs - 50%
Received within 72 hrs - 25%
- Length of Time Drugs are
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
Protection from Infection if PEP given
View Abstract) :
28 days - 100%
10 days - 50%
3 days - 0%
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