What is the postexposure prophylaxis (PEP) regimen for healthcare personnel exposed to HIV?

Updated: Jul 27, 2020
  • Author: Ana Elizabeth Markelz, MD, FACP, FIDSA; Chief Editor: John Bartlett, MD  more...
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Answer

Answer

Updated guidelines from the United States Public Health Service (USPHS) and New York State Department of Health AIDS Institute recommend that, after any occupational exposure to HIV, healthcare personnel should immediately receive a postexposure prophylaxis (PEP) three-drug regimen. [1, 2] Specific recommendations also include the following:

  • Primary prevention strategies are emphasized, along with prompt reporting and management of occupational exposures.
  • The HIV status of the source of the exposure should be determined to guide the need for HIV PEP; if the HIV status of the source is unknown, it should be determined, usually with a rapid and reliable test such as the fourth-generation HIV test. If there is a concern about a false-negative result (eg, result is negative but there has been a risk for HIV transmission to the source prior to test detection, about 4-10 days for tests that detect Ag and/or Ab, including the fourth-generation test), plasma HIV RNA (HIV viral load) testing of the source is recommended.
  • PEP should be initiated as soon as possible, ideally within hours of exposure; a first dose of PEP should be offered to the exposed worker while the evaluation is underway if HIV transmission is considered credible.
  • A PEP supply for 3-5 days is available for urgent use, and the exposed worker obtains a continuous supply to complete the 28-day course.
  • Follow-up appointments should begin within 72 hours of HIV exposure and should include follow-up HIV testing, monitoring for drug toxicity, and counseling.
  • Repeat HIV testing should be obtained at 6 weeks and 4 months postexposure. Testing should be performed using the fourth-generation assay; if a fourth-generation assay is unavailable, repeat HIV testing should be obtained at 6 weeks, 12 weeks, and 6 months postexposure. An HIV viral load should be obtained if the exposed healthcare worker has symptoms of acute retroviral syndrome.

Updated guidelines should be distributed to emergency physicians and other providers as needed; many healthcare personnel exposures occur outside of normal office hours. Clinicians who do not have access to experienced HIV clinicians should call the National Clinicians' Consultation Center PEP Line at 1-888-448-4911.


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