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Peter L. Havens, Medical College of Wisconsin and MACC Fund Research Center, Milwaukee, WI,
Kenneth L. Dominguez, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
This chapter addresses HIV postexposure prophylaxis (PEP) in the following situations: injury from discarded needles, bite wounds, sexual exposure, and inadvertent exposure to human milk from an HIV-infected woman. In each setting, the risk of HIV transmission is directly related to the probability that the exposure source has HIV infection and that transmission of a sufficient amount of infectious virus occurred in a manner that could result in infection in the recipient. Because no studies have directly measured the effectiveness of PEP in decreasing the risk of HIV transmission in non-occupational settings or after mucosal exposure, the potential benefit of PEP in modifying transmission risk is extrapolated from data regarding HIV pathogenesis in animals, from information about PEP for needle-stick injuries in occupational settings, and from studies of mother-to-child transmission (MTCT) of HIV. Guidelines for prophylaxis after exposure to HIV in occupational and non-occupational settings have been published by the US Public Health Service (USPHS) [1–3], the American Academy of Pediatrics , the NY State Department of Health , and others .
Factors affecting HIV transmission risk after potential exposure
Type of source material
Not all body fluids from persons with HIV infection are equally infectious (Table 17.1). Blood and fluids contaminated with blood from persons with HIV infection are assumed to contain HIV and are associated with the highest risk of HIV transmission.
Postexposure prophylaxis (PEP) refers to the timely administration of antiretroviral (ARV) chemoprophylaxis to reduce the probability of becoming infected with HIV after an acute well-defined exposure. PEP can be categorized as occupational (oPEP) or non-occupational (nPEP). This chapter summarizes the epidemiology of various types of HIV exposures, including strategies for preventing these exposures and recent findings from animal and human studies which lend support for the use of oPEP and nPEP, reviews current United States Public Health Service (USPHS) recommendations for oPEP and nPEP, and addresses special considerations regarding nPEP for pediatric patients. Prevention of mother-to-child transmission (MTCT) of HIV is addressed in Chapter 8. The USPHS oPEP recommendations continue to recommend a two-tiered system of three ARVs vs two ARVs, depending on level of risk. The chapter highlights a change in the USPHS nPEP recommendations, which now emphasize the importance of using three-drug regimens, when feasible, for all exposures that warrant PEP in order to be consistent with the current standard of care regarding treatment of established HIV infection.
Occupational postexposure prophylaxis
For the purposes of this chapter, healthcare personnel (HCP) are defined as persons whose activities involve contact with patients or with patients' blood or other body fluids in a healthcare, laboratory, or public-safety setting .
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