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New Guidelines for Managing Occupational Exposures to HIV

Recommendations consider new drugs and tests (August 6)

New guidelines from the U.S. Public Health Service update the recommendations for the management of health care personnel (HCP) with occupational exposure to human immunodeficiency virus (HIV) and the use of post-exposure prophylaxis (PEP).

The guidelines, published online in Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA), emphasize the immediate use of a PEP regimen containing three or more antiretroviral drugs after occupational exposure to HIV.

The PEP regimens recommended in the guidelines encourage the consistent use of a combination of three or more drugs that are better tolerated than those recommended in the previously published guidelines from 2005, for all occupational exposures to HIV. The guidance eliminates the previous recommendation to assess the level of risk associated with individual exposures to help determine the appropriate number of drugs recommended for PEP.

According to the guidelines, expert consultation should be sought, but not at the expense of delaying treatment. Exposed HCP taking HIV PEP should complete a full 4-week regimen and undergo follow-up HIV testing, monitoring for drug toxicity and counseling, beginning with follow-up appointments within 72 hours of the exposure. If a newer 4th generation HIV antigen/antibody combination test is used for follow-up testing, an option to conclude HIV testing at 4 months, rather than the recommended 6 months after exposure, is provided. Many of the revised recommendations are intended to make the PEP regimen better tolerated, increasing the possibility that HCP complete the full regimen.

HCP may include emergency medical service personnel, dental personnel, laboratory personnel, autopsy personnel, environmental maintenance personnel, nurses, nursing assistants, physicians, technicians, therapists, pharmacists, students, and trainees.

Source: SHEA; August 6, 2013.

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