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Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis

This report updates U.S. Public Health Service recommendations for the management of health-care personnel (HCP) who have occupational exposure to blood and/or other body fluids that might contain human immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis (PEP) regimens and the duration of HIV follow-up testing for exposed personnel have been updated. This report emphasizes the importance of primary prevention strategies, the prompt reporting and management of occupational exposures; adherence to recommended HIV PEP regimens when indicated for an exposure; expert consultation in management of exposures; follow-up of exposed HCP to improve adherence to PEP; and careful monitoring for adverse events related to treatment, as well as for virologic, immunologic and serologic signs of infection. To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns, and institutions should take steps to ensure that staff are aware of both the importance of, and the institutional mechanisms available for, reporting and seeking care for such exposures.

Summary of Recommendations

  • PEP is recommended when occupational exposures to HIV occur.
  • Determine the HIV status of the exposure source patient to guide need for HIV PEP, if possible.
  • Start PEP medication regimens as soon as possible after occupational exposure to HIV and continue them for a 4-week duration.

New Recommendation

  • PEP medication regimens should contain 3 (or more) antiretroviral drugs (listed in appendix A) for all occupational exposures to HIV.
  • Expert consultation is recommended for any occupational exposures to HIV and at a minimum for situations described in Box 1.
  • Provide close follow-up for exposed personnel (Box 2) that includes counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity. Follow-up appointments should begin within 72 hours of an HIV exposure.

New Recommendation

  • If a newer 4th generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded at 4 months after exposure (Box 2). If a newer testing platform is not available, follow-up HIV testing is typically concluded at 6 months after an HIV exposure.

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