In this section
Adapted from:ANCHARD Guidelines for the management and post exposure prophylaxis of individuals who sustain nonoccupational exposure to HIV ANCHARD Bulletin No 29 September 2001
Notes: These are estimates of infection from a given HIV exposure and are derived from the higher end of the range of probability.
There is some evidence that taking zidovudine reduces the risk of transmission of HIV after an occupational exposure16. There are also documented cases of seroconversion, despite early use of zidovudine17. Since combination therapy is now the standard of treatment for established HIV infection, two or three antiretroviral medications should always be prescribed. This is called PEP. In general, HIV anti-retroviral medications can only be prescribed by S100 prescribers, accident and emergency departments, or specialised services. If the exposed person elects to take PEP, it should be commenced as soon as possible. PEP may be commenced within 72 hours of exposure. While there is no research evidence for the optimal time, it is recommended that it should be commenced within a few hours if possible. If the exposure warrants PEP, commencement should not be delayed whilst waiting for source serology results. PEP is likely to be less effective if commenced more than 24 hours after the exposure. If the source is known to be HIV positive it is important whenever possible to ascertain the HIV viral load of the source and an account of their current and past antiretroviral therapy (and reasons for stopping previous regimens). This important information may lead to modification of the exposed person’s PEP regimen. The following should be discussed with the exposed person before commencing PEP:
Patient consent to PEP after discussing the factors above should be documented in the medical record. If the exposed person is pregnant and the exposure is significant, the use of PEP would be strongly encouraged. If a woman acquires HIV during pregnancy there is an increased risk of the child becoming infected. There is a large body of evidence demonstrating reduction in transmission from mother to child with the use of HIV prophylaxis17. Many anti-retroviral medications can be safely used in pregnancy. An experienced HIV physician should always be consulted about the appropriate regimen, however zidovudine can always be given while waiting for further advice.