Info

HIV SC unknown HIV SC unknown

' Exceptions can be considered wticn tlieie lias boon prolonged, high-volume contact • See page 2 tor abbreviations

St*p 3: Determine Post-E^poauro Prophylaxis (PEP) Recommendation

1 1 Consider basic logtmen'"

1 2 Recommend basic legmen'"

2 I Recommend basic teamen"

2 2 Recommend expanded legmen'

3 I or 2 Recommend expanded legimen'

1 2. 3 Unknown II exposure selling suggests nsks ol HIV exposure, consider basic legimen' *

* Based on eslimales ol i nsk ol inleclion altei mucous membrane exposuie in occupational selling compared wtlh needlestick

Modification of CDC recommendations

* Ol. consider expanded regimen'

* In high nsk gicumslances. conswler expanded legmen' on case-by-case basis

Around the clock, urgent expert consultation available from: National Clinicians' Poat-Expoeure Prophylaxis Hotline (PEPIIne) at 1-888-448-4911 (1-888-HIV-4911)

Regimens: (Treat lor 4 weeks, monitor lor drug slde-etfects every 2 weeks) Baalc regimen: ZDV + 3TC or FTC • TDF. ol possibly d4T - 3TC Expanded regimen: Basic tegimen t- one ol the lollowing loplnavit/iilonavii. nellinavii. indinavn/ntonav» losamprcnavit/rllonavii. atazanavU (oi alozonavit/iitonaviil. efaweriz can lie considerod (except in piegnancy or potential lor pregnancy Pregnancy Category 0). lull CNS symptoms mighl be problematic |Do not uae neviraplne serious odverse reactions indudinq hopatic necrosis loporled in lieaitlicaie workers (MMWfi 49 i 153. 2001) \ Other regimens can be designed II possible, use 2 antireltovirni drugs that source pt (it known) is nof currently taking or Inr which resistance is unlikely based on susceptibility data or trealmont history Seek expert consultation it ARV-oxperienced source or in pregnancy or potential tor prognancy

NOTE: Some authorities fool that an expanded regimen should be employed whenevct PEP is metaled INEJM 349 1091. 2003: Eur J Epidemiol 19 577. 2004. 4 W Stale AIDS Institute. 2004) Fa exampki the latter recommends ZDV + 3TC • tenolowi

(www hrvguideAnos org/pubhc Nml/center/clrnical^idelines/popj)uidelmsl^_guidelines htm) Expanded tegimens atelikdy lo be advanlageous with T lumbers ol ART experienced souice |is or wtien there is doubt about exact extent ot exposuies in decision algorithm Mathematical model suggests that tindet some conditions completion ol lult coutse basic ingimen is botler than prematurely disconlinued expanded regimen (CID 39 395. 2004) However while expanded PEP legimens have T adverse effects, there Is nol necessarily T discontinuation (C/D 40205. 2005)

P05T-S<M>5URE PH6PHVLAXI5 K)h Hg>t4-6C<:UpAViONAL EXPOSURES TO HIV

From MMWB 54(RR-2) 1. 2005—OHHS recommendations_

Because Hie risk ol transmission ol HIV via sexual conlacl or shanng needles by in|eclion drug users may reach ot exceed lhal ol occupational needlestick exposure, il is reasonable to consider PEP m poisons who have had a non-occupational exposute lo blood or othet potentially infected fluids (e g genilal/ieclal secretions, breast milk) Irom an HIV • source Risk ol HIV acquisition pet exposuie vanes with the act (lor needle sharing and receptive anal intercourse, 20 5%. appioximateiy 10-lold lower with insetlive vaginal cx anal inleicourse 0 05-0 07%) Overt or occult traumatic lesions may T nsk m survrvots ol sexual assault

For pis at nsk ol HIV acouisition through non-occupational exposure to HIV-t source material having occuned S72 hours belcxe evakjalmn DHHS lecommendation is to tieat lor 28 days vnth an anti letioviral expanded regimen using preferred legimens [etavwenz (not m (veqnanry or pregnancy nsk Pregnancy Category 0) * (3TC or FTC) + (ZDV or TDF|| or |lopinaw/iitonavii « (3TC or FTC) i ZDV] or one ol several alternative reganens ¡see Table 14C section 8 4 MMVW 54(RR-2) 1. 2005/

Areas of uncertainty (1) expanded tegiriiens aro nol proven lo be superior lo 2-drug regimens, (2) while PEP not lecommended tor exposures >72 houts before evaluation, if may possibly be effective In some cases. (3) when HIV status olsource patient is unknown, decision to treat and regimen selection must be individualized based on assessment ol specific ciicumstancos

Evaluate lor exposuies lo Hep B, Hep C (see Occupational PEP above), and bacterial sexually-transmitted diseases ¡see Table 15A 4 MMVW 5f(Rfl-6) I. 2002) and Heat as indicated

• Soo (tage 2 lor abbreviations

TABLE 15E: PREVENTION Of OPPORTUNISTIC INFECTION IN HUMAN STEM CELL TRANSPLANTATION (HSCT) OR SOLID ORGAN TRANSPLANTATION (SOT)

FOR ADULTS WITH NORMAL RENAL FUNCTION' Gwml comments See Taille 1SF. page 132 loi typical liming ot inlections post-transplant Rotoroncns MMWP 4<>(RR-10) 1. 2000; CID 33 S26. 2001 COO 17 35-1. 2004

TABLE 15E: PREVENTION Of OPPORTUNISTIC INFECTION IN HUMAN STEM CELL TRANSPLANTATION (HSCT) OR SOLID ORGAN TRANSPLANTATION (SOT)

FOR ADULTS WITH NORMAL RENAL FUNCTION' Gwml comments See Taille 1SF. page 132 loi typical liming ot inlections post-transplant Rotoroncns MMWP 4<>(RR-10) 1. 2000; CID 33 S26. 2001 COO 17 35-1. 2004

OPPORTUNISTIC INFECTION (at risk)

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