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

Although preventing blood exposures is the primary means of preventing occupationally acquired human immunodeficiency virus (HIV) infection, appropriate postexposure management is an important element of workplace safety. In January 1990, CDC issued a statement on the management of HIV exposures that included considerations for zidovudine (ZDV) use for postexposure prophylaxis (PEP).⁽¹⁾ At that time, data were insufficient to assess the efficacy of ZDV as a prophylactic agent in humans or the toxicity of this drug in persons not infected with HIV. Although there are still only limited data to assess safety and efficacy, additional information is now available that is relevant to this issue.

In December 1995, CDC published a brief report of a retrospective case-control study of health-care workers (HCWs) from France, the United Kingdom, and the United States exposed percutaneously to HIV; the study identified risk factors for HIV transmission and documented that the use of ZDV was associated with a decrease in the risk for HIV seroconversion.⁽²⁾ This information, along with data on ZDV efficacy in preventing perinatal transmission⁽³⁾ and evidence that PEP prevented or ameliorated retroviral infection in some studies in animals,⁽⁴⁾ prompted a Public Health Service (PHS) interagency working group*, with expert consultation,⁽⁵⁾ in June 1996 to issue provisional recommendations for PEP for HCWs after occupational HIV exposure.⁽⁶⁾

Since the provisional recommendations were released, several new antiretroviral drugs have been approved by the Food and Drug Administration (FDA), and more information is available about the use and safety of antiretroviral agents in exposed HCWs.^(7-10) In addition, questions have been raised about the use of chemoprophylaxis in situations not fully addressed in the 1996 recommendations, including when not to offer PEP, what to do when the source of exposure or the HIV status of the source person is unknown, how to approach PEP in HCWs who are or may be pregnant, and considerations for PEP regimens when the source person's virus is known or suspected to be resistant to one or more of the antiretroviral agents recommended for PEP.

In May 1997, a meeting of expert consultants, convened by CDC to consider the new information, prompted a PHS interagency working group** decision to issue updated recommendations. This document addresses the management of occupational exposure to HIV, including guidance in assessing and treating exposed HCWs, updates previous recommendations for occupational postexposure chemoprophylaxis, and updates and replaces all previous PHS guidelines and recommendations for occupational HIV exposure management for HCWs. Included in this document is an algorithm to guide decisions regarding the use of PEP for HIV exposures. The algorithm and these recommendations together address most issues that may be encountered during postexposure follow-up. As relevant information becomes available, updates of these recommendations will be published. Recommendations for nonoccupational (e.g., sexual or pediatric) exposures are not addressed in these guidelines.

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* This interagency working group comprised representatives of CDC, the Food and Drug Administration, the Health Resources and Services Administration, and the National Institutes of Health.

** This interagency working group comprised representatives of CDC, FDA, and the National Institutes of Health. Information included in these recommendations may not represent FDA approval or approved labeling for the particular product or indications in question. Specifically the terms "safe" and "effective" may not be synonymous with the FDA-defined legal standards for product approval.

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