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Public Health Service Guidelines for the Management of Possible Sexual, Injecting-Drug-Use, or Other Nonoccupational Exposure to HIV, Including Considerations Related to Antiretroviral Therapy

September 25, 1998

Introduction


The most effective methods for preventing human immunodeficiency virus (HIV) infection remain those that protect against exposure to HIV. Antiretroviral therapy should never replace adopting and maintaining behaviors that guard against HIV exposure (e.g., sexual abstinence, sex only with an uninfected partner, consistent and correct condom use, abstinence from injecting-drug use, and consistent use of sterile equipment by those unable to cease injecting-drug use). Medical treatment after sexual, injecting-drug-use, or other nonoccupational HIV exposure * is likely to be a relatively ineffective method for preventing HIV infection compared with preventing exposure in the first place. The Public Health Service (PHS) has recommended using antiretroviral drugs to reduce the acquisition of HIV infection among persons exposed in the workplace (e.g., accidental needlesticks received by health-care workers).(1,2) Although health-care providers and others have proposed offering antiretroviral drugs to persons with unanticipated sexual or injecting-drug-use HIV exposures,(3,4) no data exist regarding the effectiveness of such therapy for these types of exposures.**

In July, 1997, CDC sponsored the External Consultants Meeting on Antiretroviral Therapy for Potential Nonoccupational Exposures to HIV. This meeting brought together scientists, public health experts, clinicians, members of professional associations, representatives from industry, ethicists, and members of affected communities to discuss concerns related to providing antiretroviral agents to persons after nonoccupational HIV exposure. This report reviews the topics raised at the meeting, discusses background information on patient management options, and presents considerations for antiretroviral therapy.



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*In this report, a sexual exposure that can place a person at risk for HIV infection is defined as a discrete penetrative sex act (e.g., acts involving the insertion of the penis into the vagina, anus, or mouth) involving vaginal, anal, penile, or oral contact with the sex partner's potentially infectious body fluids, including substances that have been implicated in the transmission of HIV infection (i.e., blood, semen, vaginal secretions, or other body fluids when contaminated with visible blood).

A nonsexual, nonoccupational exposure (excluding perinatal exposures) that can place a person at risk for HIV infection is defined as a percutaneous penetration (e.g., a needlestick, injection, piercing, or cut with a sharp object); contact with mucous membranes; or contact with skin (especially when the involved skin is chapped, abraded, or affected by dermatitis; when the contact is prolonged; or when the involved area is extensive) and substances that have been implicated in the transmission of HIV infection (i.e., blood, tissues, or other body fluids when contaminated with visible blood).

**Information included in these recommendations may not represent Food and Drug Administration approval or approved labeling for the particular products 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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This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication Morbidity and Mortality Weekly Report. Visit the CDC's website to find out more about their activities, publications and services.
 

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