Diferencia entre revisiones de «HIV post-exposure prophylaxis»

Sin resumen de edición
Sin resumen de edición
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*Pregnancy test
*Pregnancy test


==Regimens (CDC)==
==Management==
#Basic (2-Drug)
##Tenofovir-Emtricitabine 300mg/200mg (Truvada): 1 tab PO QD
##OR, Zidovudine-Lamivudine 300mg/150mg (Combivir)^: 1 tab PO BID
#Expanded (3-Drug)
##Ritonavir-Lopinavir 50mg/200mg(Kaletra): 2 tabs PO BID
###PLUS tenofovir-emtricitabine OR zidovudine-lamivudine
 
^Prefered in pregnancy
 
National HIV/AIDS Clinicians' Consultation Center: 888-448-4911
 
==Treatment==
===Negligible Risk===
===Negligible Risk===
*NOT recommended
*NOT recommended
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;CDC no longer recommends that the severity of exposure be used to determine the number of drugs to be offered in an HIV PEP regimen, and a regimen containing 3 (or more) antiretroviral drugs is now recommended routinely for all occupational exposures to HIV.  <ref>Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis.  August 6, 2013. http://www.jstor.org/stable/10.1086/672271 DOI: 10.1086/672271 </ref>
;CDC no longer recommends that the severity of exposure be used to determine the number of drugs to be offered in an HIV PEP regimen, and a regimen containing 3 (or more) antiretroviral drugs is now recommended routinely for all occupational exposures to HIV.  <ref>Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis.  August 6, 2013. http://www.jstor.org/stable/10.1086/672271 DOI: 10.1086/672271 </ref>


===National Clinician's Post-Exposure Prophylaxis Hotline===
===National Clinician's Post-Exposure Prophylaxis Hotline===
*1-888-448-4911, call for expert advice
*1-888-448-4911, call for expert advice
===HIV===
*Consider Post Exposure Prophylaxis (PEP)
*Initiate within 72h (best within 36h) x 28d
*Zidovudine 300mg bid or 200mg tid + Lamivudine 150mg bid
OR
*Tenofovir + Emtricitabine


==See Also==
==See Also==
Línea 98: Línea 78:


==Source==
==Source==
<references/>


[[Category:ID]]
[[Category:ID]]

Revisión del 05:03 15 ene 2015

Background

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

Exposure Transmission Risk

Exposure^
Risk
Percutaneous 0.3%
Mucocutaneous 0.09%
Needle-sharing injection drug 0.7%
Receptive anal intercourse 0.5%
Receptive penile-vaginal intercourse 0.1%
Insertive anal intercourse 0.07%
Insertive penile-vaginal intercourse 0.05%
Receptive oral (male) intercourse 0.01%
Insertive oral (male) intercourse 0.005%

^assumes no condom use

High Risk Exposures

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

Workup (Before Giving)

  • CBC
  • C7
  • LFTs
  • Pregnancy test

Management

Negligible Risk

  • NOT recommended

Substantial Risk

  • CDC preferred regimen:
    • Raltegravir (isentress) 400 mg PO twice daily, plus
    • Truvada (tenofovir 300 mg + emtricitabine 200 mg) 1 PO once daily
CDC no longer recommends that the severity of exposure be used to determine the number of drugs to be offered in an HIV PEP regimen, and a regimen containing 3 (or more) antiretroviral drugs is now recommended routinely for all occupational exposures to HIV. [1]

National Clinician's Post-Exposure Prophylaxis Hotline

  • 1-888-448-4911, call for expert advice

See Also

Source

  1. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. August 6, 2013. http://www.jstor.org/stable/10.1086/672271 DOI: 10.1086/672271