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Post exposure prophylaxis after a patient tests negative

Oct 6, 1998

Mr. Sowadsky

I am an RN working in Canada.Yesterday I was accidentally pricked by a syringe after having given an intramuscular injection.Afew hours after I had a baseline blood draw for HAG,HAB,HCA and HIV.The patient whose needle I was stuck by also consented to have these tests(since his status is unknown).I was prescribed the following;3TC 150 mg p.o.q2h,CRIXIVAN 400mg p.o. t.i.d and AZT 200mg b.i.d.The infection control MD informed me that if the patient's HIV test come back neg.I no longer need to take the meds.I am concerned that possibly i need to take them due to the fact that the patient may not have seroconverted as of yet.What are your thoughts on the matter?

Response from Mr. Sowadsky

Thank you for your question. Post-Exposure Prophylaxis (PEP) is recommended for significant occupational exposures to the blood of patients known to have HIV, or known to be at high risk for HIV. In a situation such as yours, the decision to discontinue therapy depends on several things.

If the patient tested negative, and there is no indication that they have been at high risk for HIV over the previous 6 months, generally speaking, you may consider discontinuing PEP, since there is no indication that they are infected.

If the patient tested negative, but it is known that they have engaged in high risk activities within the previous 6 months (for example, if it is known that they have shared IV drug needles within the previous 6 months), then you may want to consider continuing with PEP for the recommended 4 weeks of therapy.

Ultimately, the decision on whether to discontinue PEP or not, rests with you and your doctor.

Whether you continue PEP therapy or not, it is still recommended that you continue with HIV and hepatitis testing over the next 6 months. In addition, over the next 6 months, it is still important that you use condoms with all of your sexual partners, and that you do not donate blood or organs, just to be on the safe side. If you have not been previously vaccinated against hepatitis B, now is a very good time to do so.

For more information on PEP after occupational exposures, read the following report:

Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis

Morbidity and Mortality Weekly Report

Centers For Disease Control and Prevention

May 15, 1998

Vol. 47 #RR-7

(Editor's Note: If you do not have Adobe AcrobatTM Reader software with which to read the version at the CDC site, you may access a web version of this document at The Body.)

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).

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