Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis

Details

• Personal Author:
  Cheever LW ; Gomaa, Ahmed ; Henderson DK ; Heneine W ; Kuhar DT ; Panlilio AL ; Struble KA ; Thomas V
• Description:
  This report updates US Public Health Service recommendations for the management of healthcare personnel (HCP) who experience occupational exposure to blood and/or other body fluids that might contain human immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis (PEP) regimens and the duration of HIV follow-up testing for exposed personnel have been updated. This report emphasizes the importance of primary prevention strategies, the prompt reporting and management of occupational exposures, adherence to recommended HIV PEP regimens when indicated for an exposure, expert consultation in management of exposures, follow-up of exposed HCP to improve adherence to PEP, and careful monitoring for adverse events related to treatment, as well as for virologic, immunologic, and serologic signs of infection. To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns, and institutions should take steps to ensure that staff are aware of both the importance of and the institutional mechanisms available for reporting and seeking care for such exposures. The following is a summary of recommendations: (1) PEP is recommended when occupational exposures to HIV occur; (2) the HIV status of the exposure source patient should be determined, if possible, to guide need for HIV PEP; (3) PEP medication regimens should be started as soon as possible after occupational exposure to HIV, and they should be continued for a 4-week duration; (4) new recommendationPEP medication regimens should contain 3 (or more) antiretroviral drugs (listed in Appendix A) for all occupational exposures to HIV; (5) expert consultation is recommended for any occupational exposures to HIV and at a minimum for situations described in Box 1; (6) close follow-up for exposed personnel (Box 2) should be provided that includes counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity; follow-up appointments should begin within 72 hours of an HIV exposure; and (7) new recommendationif a newer fourth-generation combination HIV p24 antigen--HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded 4 months after exposure (Box 2); if a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after an HIV exposure. [Description provided by NIOSH]
• Subjects:
  Acquired Immunodeficiency Syndrome Blood Blood-Borne Pathogens Body Fluids Communicable Diseases Drug Therapy Emergency Responders Health Care Facilities Workforce And Services Health Personnel Hematologic Diseases Occupational Exposure Occupational Health Risk Assessment Safety Viral Diseases

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• Keywords:
  AIDS Aids-prevention AIDS-virus Bloodborne-pathogens Body-fluids Disease-prevention Drug-therapy Emergency-care Health-care Health-care-facilities Health-care-personnel Health-care-workers Humans Immune-system-disorders Infection-control Infection-prevention Infectious-diseases Occupational-exposure Paramedical-services Prophylaxis Risk-analysis Serological-techniques Sexually-transmitted-diseases Surveillance-programs Viral-diseases Viral-infections

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• ISSN:
  0899-823X
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Georgia ; Maryland ; Ohio ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  34
• Issue:
  9
• NIOSHTIC Number:
  nn:20043121
• Citation:
  Infect Control Hosp Epidemiol 2013 Sep; 34(9):875-892
• Contact Point Address:
  David T. Kuhar, MD, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS A-31, Atlanta, GA 30333
• Email:
  jto7@cdc.gov
• Federal Fiscal Year:
  2013
• Peer Reviewed:
  True
• Source Full Name:
  Infection Control and Hospital Epidemiology
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:878ffa9ba54163e341a0b7c907f4734399b46b8bf1a3ddf5aa6ffa330ba090648a766c6c3e82d5e6880bb4ad8c67691d621ae047e8fc9fccd4cacf2acb11bcd3
• Download URL:
  https://stacks.cdc.gov/view/cdc/195128/cdc_195128_DS1.pdf
• File Type:
  [PDF - 299.13 KB ]