Updated guidelines issued on post-HIV-exposure prophylaxis

Health care workers with any occupational exposure to HIV should immediately use a post-exposure prophylaxis regimen comprising three or more antiretroviral drugs, according to updated guidelines from the U.S. Public Health Service Commissioned Corps.

Previously, the guidelines recommended assessing the level of risk associated with individual exposures in order to determine how many drugs to use for post-exposure prophylaxis (PEP). The guidelines also recommend taking a full four-week PEP regimen and undergoing close follow-up HIV testing that includes counseling and monitoring for drug toxicity. Follow-up appointments should start within 72 hours of exposure. These guidelines update the 2005 version and were published online Aug. 6 by Infection Control and Hospital Epidemiology.

If a newer, fourth-generation combination HIV p24 antigen-HIV antibody test is used for follow-up testing, the testing can be finished four months after exposure, the guidelines said. If a newer testing platform is not available, however, follow-up testing should continue until six months after exposure.

When a health care worker is exposed to HIV, he or she should seek expert consultation, though not at the expense of delaying treatment, the guidelines said. Consultation can be made with local experts or by calling the National Clinicians' Post-Exposure Prophylaxis Hotline at 888-448-4911.

Situations in which expert consultation is especially recommended include when an exposure report occurs ≥72 hours after exposure; when the exposure source is unknown; when the exposed person is pregnant, breastfeeding or has a serious illness; when the source virus is known or suspected to be resistant to antiretrovirals; and when the exposed person experiences toxicity from the initial PEP regimen.

The guidelines were developed by an interagency Public Health Service working group comprising representatives from the Centers for Disease Control and Prevention, National Institutes of Health, Food and Drug Administration and the Health Resources and Services Administration, in consultation with an external expert panel. They apply to a wide range of workers, including laboratory personnel, physicians, technicians, pharmacists, nurses, students, trainees, volunteers and emergency medical personnel.