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Three-drug ART regimen recommended for health care personnel exposed to HIV
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The United States Public Health Service has updated its guidelines for managing health care personnel who are exposed to HIV, emphasizing the need for immediate use of postexposure prophylaxis with three or more antiretroviral therapy drugs for 4 weeks.
The guidelines, published in Infection Control and Hospital Epidemiology, urge clinicians to consider occupational exposure to HIV as an urgent medical concern and begin postexposure prophylaxis (PEP) as soon as possible. The recommended regimen is raltegravir (Isentress, Merck) and emtricitabine/tenofovir (Truvada, Gilead).
“Preventing exposures should be the leading strategy to prevent occupational HIV infections,” David Kuhar, MD, medical epidemiologist with the CDC’s Division of Healthcare Quality Promotion and a guidelines author, said in a press release. “However, when an exposure occurs, it should be considered an urgent medical concern and a PEP regimen should be started right away, ideally within hours of the potential exposure.”
The guidelines have changed from the 2005 standards and recommend that a three-drug PEP regimen be used for all occupational exposure to HIV. Previously a two-drug PEP regimen was recommended. The new recommendation also states that HIV testing should conclude at 4 months if a newer, fourth-generation combination HIV p24 antigen–HIV antibody test is used for follow-up. Otherwise, testing will be complete at 6 months, as previous guidelines suggested.
Other recommendations include expert consultation for occupational exposures to HIV in certain situations, including delayed exposure report, unknown source of infection, known or suspected pregnancy or breast-feeding, known or suspected resistance of source to ART, toxicity of the initial PEP regimen or serious medical illness in the exposed person. Counseling, monitoring for drug toxicity and follow-up testing also are encouraged.
The guidelines were developed by a Public Health Service working group that included individuals from the CDC, NIH, FDA and the Health Resources and Services Administration, with consultation from external experts.
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Disclosure: See the study for a full list of relevant financial disclosures.