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New Guidelines for Management of Occupational Exposure to HIV
HIV Post exposure Prophylaxis (PEP)
April 2007 Dr. Niel Ampil SAVAHCS HIV Research/Education
| Evaluate Risk of Percutaneous Exposure |
| High Risk: |
Increased Risk: |
No Increased Risk: |
| BOTH larger volume of blood (e.g., deep injury, large-diameter needle previously in source patient’s vein or artery) AND high titer of HIV (e.g., source patient with acute retroviral illness or end-stage AIDS) |
EITHER larger volume of blood OR high titer of HIV |
No larger volume of blood
No high titer of HIV
(e.g., injury with a solid suture needle from source patient with asymptomatic HIV) |
| Summary Recommendations for PEP |
| Exposure Type: PERCUTANEOUS |
| Source |
Prophylaxis |
Regimen* |
| Blood-Highest Risk |
Recommend |
Kaletra 200mg/50mg ii (two) po BID
Truvada 200mg/300mg i (one) po qd |
| Blood- Increased Risk |
Recommend |
Kaletra 200mg/50mg ii (two) po BID
Truvada 200mg/300mg i (one) po qd |
| Blood- No Increased Risk |
Offer |
Kaletra 200mg/50mg ii (two) po BID
Truvada 200mg/300mg i (one) po qd |
| Fluid containing visible blood, other potentially infectious fluid, or tissue |
Offer |
Kaletra 200mg/50mg ii (two) po BID
Truvada 200mg/300mg i (one) po qd |
| Other body fluid (e.g., urine) |
Don’t offer |
Kaletra 200mg/50mg ii (two) po BID
Truvada 200mg/300mg i (one) po qd |
| Exposure Type: MUCOUS MEMBRANE |
| Source |
Prophylaxis |
Regimen* |
| Blood |
Offer |
Kaletra 200mg/50mg ii (two) po BID
Truvada 200mg/300mg i (one) po qd |
| Fluid containing visible blood, other potentially infectious fluid, or tissue |
Offer |
Kaletra 200mg/50mg ii (two) po BID
Truvada 200mg/300mg i (one) po qd |
| Other body fluid (e.g., urine) |
Don’t offer |
| Exposure Type: SKIN-INCRAESED RISK (e.g., exposure to high titer of HIV, prolonged contact, extensive area involved, or skin is visibly compromised) |
| Source |
Prophylaxis |
Regimen* |
| Blood |
Offer |
Kaletra 200mg/50mg ii (two) po BID
Truvada 200mg/300mg i (one) po qd |
| Fluid containing visible blood, other potentially infectious fluid, or tissue |
Offer |
Kaletra 200mg/50mg ii (two) po BID
Truvada 200mg/300mg i (one) po qd |
| Other body fluid (e.g., urine) |
Don’t Offer |
If PEP is offered, the recommended course of treatment is 4-6 weeks.
*Please refer to manufacturers’ full prescribing information for dosing and other information
Follow-up
Any adverse events associated with PEP, as well as signs and symptoms of possible retroviral illness (e.g., fever, enlargement or tenderness of lymph nodes, rash), should be reported.
Recommended laboratory testing for an occupational exposure to HIV: HIV antibody: baseline, 6 weeks,12 weeks, and 6 months post exposure. Drug toxicity: baseline and 2 weeks post exposure (CBC, renal, hepatic function).
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