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Infection via eye mucosa and PEP-Follow up please

May 29, 2009

Dear dr. Young

Thank you for your swift answer. I decided not take PEP, since the source patient was of unknown HIV status and the source patient was with low HIV risk factors ( married family women with a 3 year old child). (I knew I could have asked her to be tested but in my country there is quite stigma about HIV).

When I looked at recommendations from the CDC: "Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis", I found out that they did not recommend the PEP in case of source of unknown HIV status in case of mucous membrane exposures regardless of volume.

They made a distinction between small volume and large volume saying that only in case of large volume of unknown source one should consider PEP for source with high HIV risk factors. In case of small volume they simply did not recommend PEP when source was unknown ( not going into hiv risk factors analysis).

So I guess that CDC concluded that a sum of overall risk 0.1% combined with small volume ( probably low end spectrum of the interval with mean of 0.1%) and unknown status of source makes such risks quite remote, that even HIV risk factors for source patient are not to be analyzed ( with small volume).

I do understand your position in answering my question as I would never not recommend PEP in case of possible exposure regardless of how remote it was.

Could you please comment on the CDC position of not recommending PEP in case of mucous membrane exposure if source is of unknown status or if the source was unknown.

Kind regards and many thanks.

Response from Dr. Young

Thanks for the follow up; I'm never one to try to interpret the CDC, but I think it has to come from a relative risk standpoint and one that is based more on non-occupational exposure rather than a medical exposure (ie, with fluids that are often derived from percutaneous devices).

Part of the issue is what the relative risk of HIV infection is in the population of "unknowns" that are under care- in your case, perhaps lower, but sounds like you might not be in the US (or EU?); my knowledge of the relative risks or epidemiology among such individuals is low. The way I look at it is risk is largely binary. If there was sufficient basis to think that there might be exposure, then I'll recommend PEP.

I'm not sure that this provides a definitive answer to your question, just background.

Be well, BY

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