Virus-Specific Post-Exposure Management

HIV:

Use of post-exposure prophylaxis can help to reduce the risk of contracting HIV. Maximal benefit can be obtained by initiating treatment within hours of exposure. Guidelines include the following:

• Start post-exposure prophylaxis as soon as possible.
• Reevaluate the exposed individual within 72 hours, particularly focusing on new information regarding the source and the exposure.
• If the source is determined to be HIV-negative, post-exposure prophylaxis can be discontinued.
• If the source is determined to be HIV-positive, continue treatment for 4 weeks if tolerated.
• All workers exposed to HIV should undergo HIV antibody testing at 6 weeks, 12 weeks, and 6 months.

A few additional considerations regarding HIV exposure management:
There is the possibility of toxicity with antiretrovirals, so use should be restricted to exposures in which reasonable risk of transmission is present.

• 2-drug therapy (with 2 nucleoside analogues) is recommended, although 3-drug therapy may be warranted under certain circumstances (ie, a source with a high viral load or known drug resistance).
• One should inform the treating physician about pregnancy status and current medications because these can influence the selection of a treatment regimen.

HBV:

The treatment after exposure varies based on the vaccination status of the exposed individual and the HBV status of the patient:

• Regardless of the status of the patient, if an individual suffers a needlestick and is unvaccinated, the vaccination series should be initiated.
• If an individual has been vaccinated and has a documented response to the vaccine, then no treatment is required after an exposure.
• If the vaccination status of the exposed individual is unknown, he or she should be tested for anti-HBs before deciding on treatment.

HCV:

No treatment has been shown to prevent infection for workers exposed to HCV. Recommendations center on following workers after the injury and monitoring for HCV RNA in the serum. Recommendations include:

• Begin testing for HCV antibodies, HCV RNA levels, and alanine aminotranferase (ALT) levels immediately after the event.
• Repeat testing 2-8 weeks later.
• If infection occurs, the health care worker should be referred to a specialist for management.