HIV post-exposure prophylaxis

Workup

1. Td
2. Hepatitis B PEP for non-vaccinated
   1. Hepatitis B immunoglobulin and/or vaccine
3. Source labs
   1. Rapid HIV, hep pannel, RPR?
4. Exposed labs
   1. Rapid HIV, hep pannel, RPR?
5. Consider HIV PEP
   1. CBC, C7, LFTs, Icon if considering HIV PEP

^Currently no PEP for Hep C

HIV PEP

• ~79% transmission reduction
• Initiate ASAP (goal = 1-2 hours)
• >36 hours: normally deferred, unless particularly high risk
• Common side-effects = constitutional, gastrointestinal

Specific Regimens (CDC)

1. Basic
   1. Exposures for which there is a recognized transmission risk
   2. 4 week, 2 drug regimen (normally zidovudine and lamivudine)
2. Expanded
   1. High risk exposures
   2. Basic regimen + protease inhibitor (e.g. indinavir or nelfinavir)

High Risk

Source

1. Symptomatic HIV/AIDS
2. Acute seroconversion
3. High viral load

Exposure

1. Deep injuries
2. Visible blood on device
3. Injuries sustained placing a catheter in a vein/artery

Source

8/07 DONALDSON