A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...
A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...
A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
A <strong>Guide</strong> <strong>to</strong> <strong>Primary</strong> <strong>Care</strong> <strong>of</strong> <strong>People</strong> <strong>with</strong> <strong>HIV</strong>/<strong>AIDS</strong><br />
Chapter 11: Postexposure Prophylaxis<br />
11<br />
Table 11-5. Labora<strong>to</strong>ry Evaluation and<br />
Followup <strong>of</strong> Exposed Health <strong>Care</strong> Personnel<br />
Lab tests Comment Frequency<br />
<strong>HIV</strong> antibody test<br />
HBV<br />
Anti HCV<br />
Liver enzymes<br />
CBC, renal<br />
function, and<br />
hepatic function<br />
Test HCP if source<br />
patient is <strong>HIV</strong><br />
positive regardless<br />
<strong>of</strong> whether PEP is<br />
given<br />
Test if source<br />
patient is HBsAg or<br />
HBeAg positive<br />
Test if source<br />
patient is HCV<br />
positive<br />
Test if source<br />
patient is HCV<br />
positive<br />
If PEP is warranted<br />
Baseline, 6 weeks,<br />
12 weeks, 6<br />
months (rapid<br />
test at baseline, if<br />
possible)<br />
Baseline and 4-6<br />
months ( or 1-2<br />
months after last<br />
HBV vaccine)<br />
Baseline and 4-6<br />
months; HCV RNA<br />
at 4-6 weeks is<br />
optional<br />
Baseline and 4-6<br />
months<br />
Prior <strong>to</strong> initiating<br />
PEP and repeated<br />
in 2 weeks<br />
Are there special considerations for PEP in<br />
dental settings?<br />
Although the number <strong>of</strong> exposures is relatively high<br />
in dental settings, the risk <strong>of</strong> transmission is low and<br />
no different from other HCP settings. Fac<strong>to</strong>rs that are<br />
associated <strong>with</strong> increased risk <strong>of</strong> transmission are<br />
failure <strong>to</strong> follow PEP pro<strong>to</strong>cols, failure <strong>to</strong> use puncturepro<strong>of</strong><br />
containers, treating >20 patients per day, failure<br />
<strong>to</strong> use eye protection or masks, and male gender. For<br />
more information, see Suggested Resources.<br />
INTERVENTIONS FOR<br />
NONOCCUPATIONAL PEP<br />
(NPEP)<br />
What is the role <strong>of</strong> nPEP for nonoccupational<br />
exposure?<br />
PEP for nonoccupational exposure <strong>to</strong> <strong>HIV</strong> (nPEP) is<br />
routinely being administered in cases <strong>of</strong> sexual assault<br />
in hospital emergency departments and is increasingly<br />
being made available during other cases <strong>of</strong> sexual<br />
exposure or injection drug use exposure and in nonhospital<br />
settings. This issue is particularly relevant in<br />
the care <strong>of</strong> <strong>HIV</strong> discordant couples. Research on risk<br />
<strong>of</strong> <strong>HIV</strong> transmission from a single nonoccupational<br />
exposure is relatively lacking compared <strong>with</strong><br />
occupational exposures (see Table 11-6). A national<br />
registry has been developed <strong>to</strong> gather the data <strong>with</strong><br />
which <strong>to</strong> develop a CDC recommendation for <strong>HIV</strong> PEP<br />
in the nonoccupational setting. Information about this<br />
registry can be found at http://www.hivpepregistry.org.<br />
In general, PEP for non-HCP is modeled after PEP<br />
interventions and procedures for HCP.<br />
Table 11-6. Estimated Risk <strong>of</strong> <strong>HIV</strong> Transmission<br />
Following Different Types <strong>of</strong> Exposures<br />
Type <strong>of</strong> exposure<br />
Needle-sharing exposure <strong>with</strong><br />
an infected source<br />
Receptive anal intercourse <strong>with</strong><br />
an infected source<br />
Receptive vaginal intercourse<br />
<strong>with</strong> an infected source<br />
Insertive anal intercourse <strong>with</strong><br />
an infected source<br />
Insertive vaginal intercourse<br />
<strong>with</strong> an infected source<br />
Oral sex <strong>with</strong> ejaculation <strong>with</strong><br />
an infected source<br />
0.67%<br />
Estimated risk<br />
0.5%-3.0%<br />
0.1%<br />
0.065%<br />
0.05%<br />
Conflicting data; however,<br />
risk is considered <strong>to</strong> be<br />
extremely low<br />
(