Diferencia entre revisiones de «HIV post-exposure prophylaxis»
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==Treatment== | ==Treatment== | ||
===Negligible Risk=== | ===Negligible Risk=== | ||
*NOT recommended | |||
===Substantial Risk=== | ===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. <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=== | ||
Revisión del 04:57 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
- Symptomatic HIV/AIDS
- Acute seroconversion
- High viral load
Exposure
- Deep injuries
- Visible blood on device
- Injuries sustained placing a catheter in a vein/artery
Workup (Before Giving)
- CBC
- C7
- LFTs
- Pregnancy test
Regimens (CDC)
- 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
- Ritonavir-Lopinavir 50mg/200mg(Kaletra): 2 tabs PO BID
^Prefered in pregnancy
National HIV/AIDS Clinicians' Consultation Center: 888-448-4911
Treatment
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
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
Source
- ↑ 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