hiv
HIV / AIDS
Post-exposure prophylaxis for HIV infection
the following is derived from Landovitz and Currier, NEJM 2009; 361:1768-75;
post-exposure prophylaxis appears to prevent ~80% of potential HIV transmissions but is expensive, often not well tolerated and thus the decision on prophylaxis is complicated and requires an estimate of risk-benefit for the individual patient.
risk of source HIV transmissibility
risks of transmission
occupational exposure
the overall rate of HIV transmission through percutaneous inoculation is said to be 0.3%
splashes of infectious material to mucous membranes (e.g. conjunctivae or oral mucosa) or broken skin also may transmit HIV infection (estimated risk per exposure = 0.09%)
non-occupational exposure
post-exposure prophylaxis regime
initiate as soon as possible after exposure (consider 1st dose if ELISA testing of source is likely to be delayed)
postexposure prophylaxis should be continued for 28 days
two drug regime appears to have the best cost-effective, clinical risk-benefit profile unless the source HIV population has > 15% viral resistance rates, in which case, a three-drug regime would be prudent.
compliance with Rx is a major issue and at least weekly patient contact is advised to improve compliance
two main drug regimes for low risk exposures
tenofovir–emtricitabine:
once daily dosing, well tolerated but risk of nephrotoxicity
emtricitabine 200mg + tenofovir 300 mg orally, daily for 4 weeks
zidovudine–lamivudine:
twice daily dosing, less well tolerated (more nausea, asthenia, neutropenia, anaemia, abnormal LFTs) but preferred in pregnancy
patient testing (recipient) and follow up
baseline HIV status (and hepatitis B, C)
baseline FBE, U&E, LFT if considering post-exposure prophylaxis
vaccination against hepB if no or insufficient antibodies to hep B (plus IgG if source is hep B +ve)
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follow up ELISA testing for HIV and HCV (hepatitis C) at 4-6 weeks, 3 months and 6 months after exposure
use condoms and avoid sharing razors, toothbrushes, etc until te 6 month HIV test is negative
hiv.txt · Last modified: 2018/10/14 18:33 (external edit)