Post Exposure Prophylaxis HIV

Post Exposure Prophylaxis (PEP) assessment to be done by Medical Registrar on call. Patients exposed to high risk injuries with high risk fluids should be offered PEP. Advice (in-hours only) may be available from the Registrar in Infectious Diseases in CUH. There is no routine on-call PEPSE advice service (Inf. Diseases on-call not funded in Cork).

High risk injuries

  • Percutaneous exposure particularly with hollow-bore needle
  • Needle with visible blood or deep intramuscular injury
  • Mucous membrane exposure including the eye.

High risk fluids

  • Blood
  • Fluid from peritoneum, pericardium, or synovium
  • Amniotic fluid
  • CSF
  • Vaginal secretions or semen

Low risk fluids (PEP not recommended)

  • Urine
  • Faeces
  • Saliva (unless visibly blood stained)

Assessment of source patient

Inform the patient that standard procedure involves assessing for risk factors for HIV.

  • Have you ever used intravenous drugs e.g. Heroin?
  • Have you ever received a blood transfusion or blood product before 1985?
  • Are you homosexual/bisexual/multiple sexual partners?
  • Are you known to be infected with HIV?
  • Are you a partner of anyone with the above risk factors?

Counselling of Health Care Worker exposed to HIV

  • Risk of transmission is low at 0.3% (3/1000 cases)
  • Need to practice safer sex during the 6 month HIV testing period
  • Instructed on side effects of medicine listed below
  • Clear instructions on follow-up
  • If pregnant, offer therapy assuring early follow-up

Initiation of therapy

As soon as possible following exposure, PREFERABLY WITHIN 4 HOURS, (but with 72 hours) therapy is recommended if source patient is at risk and injury is significant.

Algorithm (CUH)

PEP Algorithm CUH 2011

Print (pdf) version

Treatment & potential side effects

Combivir 1 tablet b.d.

Combivir may cause - Headache, nausea, fatigue, may lower blood count. Patient Information leaflet

Kaletra 2 tablets bd

Kaletra may cause diarrhoea, nausea, vomiting Patient Information leaflet

CUH Emergency Department

A 5 day supply of Combivir (and Kaletra) will be given, 5 day pack available in Emergency Dept. (antidotes press in Resusc. in CUH).

Monitoring

  • Every 2 weeks at Infectious Disease clinic while receiving treatment
    • Phone number for appointments, 021 546400 ext. 2795
  • At 6 weeks, 3 months, 6 months and 12 months at Occupational Health Clinic
    • Phone number for appointments 021 546400 ext. 2288
  • Toxicity monitoring
    • Symptoms
    • Focused physical examination
    • FBC (week 2,4), LFT (week 2)
  • HIV Monitoring
    • HIV antibody test at baseline, 12 weeks, 6 months
      • No advantage in testing @ 6 weeks
    • HIV viral load if health care worker experiences symptoms of acute retroviral syndrome

Links

Patient Information leaflet

Print Version CUH PEP Protocol 2009 (beware large document - 65pages)

HIV post-exposure prophylaxis: Guidance (UK Chief Medical Officer's Expert Advisory Group on AIDS) (local copy)

Post-Exposure Prophylaxis (PEP) Guidelines for children exposed to blood-borne viruses (local copy)