|Hepatitis C Virus (HCV) PEP|
HCV is not transmitted efficiently through exposures to blood in the occupational setting, and the incidence of anti-HCV seroconversion after accidental occupational exposure is 1.8% (0%-7%). Unlike HBV, data indicate that HCV does not survive well in the environment, suggesting that environmental contamination with blood is not a significant risk for HCV transmission in the health care setting (the only exception may be in the hemodialysis setting). In addition, there are no data supporting the use of IG (anti-HCV antibody) as PEP to prevent HCV transmission. None of the antivirals currently available to treat HCV infection are FDA approved for use in PEP, nor have any clinical trials been done to assess the effect of antivirals (ie interferon with or without ribavirin) as postexposure prophylaxis. Recommendations for postexposure management of HCV are to achieve early detection of chronic disease and, if present, refer to an expert for treatment options. There are data from studies done outside the US to suggest that a short course of interferon (IFN) alfa-2b therapy in the acute stage of HCV is associated with higher rates of resolved infection than when therapy is begun once chronic disease has been established (Jaeckel E., et al. NEJM 2001; 345 (20): 1452-7). The theoretical argument exists, then, that antiviral treatment at the first signs of detectable HCV RNA may prevent the development of chronic infection.
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