TABLE 9.

Management of Patients With Possible Exposure to HIV

Exposure Management IssueImplementation Comment
Treat exposure site—Wash wounds with soap and water; flush mucous membranes with water. Give tetanus booster if appropriate.
Evaluate exposure source if possible—Determine the HIV infection status of the exposure source. If unknown, testing with appropriate consent should be offered if possible.
Evaluate exposed person—Perform HIV serologic testing to identify current HIV infection and hepatitis B and hepatitis C serologic testing as appropriate122
—Provide or refer for counseling to address stress and anxiety
—Discuss prevention of potential secondary HIV transmission
—Discuss prevention of repeat exposure, if appropriate
—Report incident to legal or administrative authorities as appropriate to the setting of the exposure and the severity of the incident
Consider PEP—Explain potential benefits and risks
—Discuss issues of drug toxicity and medication compliance
—Measure complete blood cell count, creatinine, and alanine transaminase concentration as baseline for possible drug toxicity
—Begin prophylaxis as soon as possible after exposure, preferably within 1 to 4 h; prophylaxis begun more than 72 h after exposure is unlikely to be effective
—Arrange for follow-up with HIV specialist and psychologist, if appropriate
—Educate about prevention of secondary transmission (sexually active adolescent should avoid sex, or use condoms, until all follow-up test results are negative)
—Report to PEP registry at CDC
Choose therapy—Consider drug potency and toxicity, regimen complexity and effects on compliance, and possibility of drug resistance in the exposure source
—Supply 3–5 d of medication immediately, instructing patients to obtain remainder of medication at follow-up visit
Follow-up—Perform initial follow-up within 2–3 d to review drug regimen and adherence, evaluate for symptoms of drug toxicity, assess psychosocial status, and arrange appropriate referrals, if needed
—Continue therapy for 28 d
—Monitor for drug adverse effects at 4 wk with complete blood cell count and alanine transaminase concentration
—Evaluate for psychologic stress and medication compliance with weekly office visits or telephone calls
—Consider referral for counseling if needed
—Repeat HIV serologic testing at 6 wk, 12 wk, and 6 mo after exposure