POSTEXPOSURE PROPHYLAXIS

BASICS

  Infectious bodily fluids

   •  Blood

   •  Cerebrospinal fluid

   •  Semen

   •  Vaginal fluid

   •  Amniotic fluid

   •  Pericardial, peritoneal, pleural, synovial fluids

  Noninfectious bodily fluids (unless contaminated with blood)

   •  Tears, saliva, sweat, feces, vomitus, urine

MODE OF TRANSMISSION

  Percutaneous

  Cutaneous

  Mucous membrane

MANAGEMENT

  Immediate decontamination with soap and water or irrigation

  Source person: voluntary testing for HIV Ab, hepatitis C virus (HCV) Ab, HBsAg

   •  If HIV positive, obtain disease stage

  Exposed person: baseline labs including HIV Ab, HCV Ab, hepatitis B virus (HBV) surface Ag, HBV surface Ab

   •  If postexposure prophylaxis (PEP), consider

        Pregnancy test for childbearing age females

        Complete blood count, blood urea nitrogen, Cr, alanine amino transferase

  If indicated, PEP starts ASAP (≤72 hours after exposure)

TREATMENT

  Preferred HIV three-drug PEP regimen × 28 days:

   •  Raltegravir (Isentress) 400 mg po twice daily plus

   •  Truvada (tenofovir disoproxil fumarate 300 mg per emtricitabine 200 mg) 1 po once daily

  HBV: begin hepatitis B immune globulin series if not previously vaccinated

  HCV: no PEP recommended, follow ALT

 VACCINATIONS (TABLES 19.1 AND 19.2)

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