August 12, 2013
The U.S. Public Health Service (USPHS) has issued updated guidelines for managing healthcare workers' occupational exposure to HIV. Under these guidelines, healthcare workers exposed to HIV should begin treatment immediately with four weeks of post-exposure prophylaxis (PEP) with three antiretroviral drugs. This is a change from the 2005 recommendations, which suggested that the number of drugs should be based on assessment of the risk of infection. According to CDC's David Kuhar, MD, and colleagues, earlier recommendations presented a challenge because of difficulty determining risk levels.
USPHS left in place some of the old guidelines, including PEP where there is occupational exposure; investigation of HIV status of the source to determine whether PEP is necessary; immediate initiation of treatment that should last four weeks; consultation with HIV experts, particularly in complicated cases such as exposure of pregnant women, suspicion of HIV drug resistance in the source, or serious underlying illness of the exposed worker; and close follow-up with initial counseling, baseline, and follow-up testing and monitoring 72 hours after exposure.
The new recommendations shortened follow-up testing from six months to four months with the use of a fourth-generation test, as newer tests detect the HIV p24 antigen and antibodies to the virus and are more reliable than previous tests. It also recommended a preferred initial regimen -- a combination of tenofovir and emtricitabine with raltegravir -- because that regimen has a convenient dosing schedule and favorable side effects. However, those undergoing treatment still require expert consultation to adapt the treatment to the exposed individual.
The full report, "Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis," was published online in the journal Infection Control and Hospital Epidemiology (2013; doi: 10.1086/672271).