Post-exposure Prophylaxis of HIV
المؤلف:
Baijayantimala Mishra
المصدر:
Textbook of Medical Virology
الجزء والصفحة:
2nd Edition , p266-268
2025-12-10
34
This refers to the exposure to infectious blood or body fluids. This can occur either as an occupational exposure to the infected sample or due to sexual exposure with an infected individual which is referred as non-occupational exposure (Table 1).
Table1. Risk status according to type of body fluids
Non-occupational exposure: Exposure to blood-borne pathogens which occurs outside the work place and mostly due to sexual assault or unsafe sex or intravenous drug user. CDC recommends a 28-day course of nonoccupational post-exposure prophylaxis (nPEP) for HIV-uninfected persons who seek care ≤72 hours after a non-occupational exposure to blood, genital secretions, or other potentially infected body fluids of persons known to be HIV infected or of unknown HIV status when that exposure represents a substantial risk for HIV acquisition (men who has sex with men, intra venous drug user, or any other high-risk behavior).
Occupational exposure: Exposure to blood borne pathogens which occurs during the working period. This pertains to exposure to percutaneous injury, mucous membrane, nonintact skin or intact skin for a prolong period. This occurs mostly in a hospital set up with health care workers. NACO gives a guideline for a comprehensive management in order to minimize the risk of infection after expo sure to blood-borne pathogens (Table 2). This encompasses:
1. First aid of the site of exposure
2. Counselling
3. Risk assessment
4. Provision of antiretroviral prophylaxis
5. Follow-up
Table2. NACO guideline for post-exposure prophylaxis (occupational), 2018
It is to be noted that post-exposure prophylaxis for HIV needs to be started at the earliest possible time, preferably within 2 hours of exposure and maximum within 72 hours. Therefore, it necessitates an early risk assessment.
First aid: As a first step in the management, the area exposed needs to washed or rinsed with water or normal saline. No soap, antiseptic or disinfectant should be used.
Assessment of exposed individual’s HIV status: If the exposed individual is not a known HIV positive, his/her sample also should be tested for HIV as per the national guideline with counselling and informed consent to know their pre-existing HIV status. If found positive, then person be referred for assessment for ART and should not receive post-exposure prophylaxis.
Assessment of source’s risk status: Source should be tested for HIV testing following the national guideline and with informed consent. However, prophylaxis initiation should not be delayed due to pending test result.
Assessment of risk exposure: By establishing source’s risk status and level of exposure:
Source’s HIV status code (SC)
• SC-1: HIV positive, asymptomatic, low viral load, high CD4 count.
• SC-2: HIV positive, symptomatic, high viral load, low CD4 count.
• SC unknown: Source’s status not known and sample also not available for testing.
• HIV negative: HIV test result negative.
Exposure code (EC)
EC-1: Mild exposure: Exposure to mucous membrane or non-intact skin with small volume and less duration.
EC-2: Moderate exposure:
• Mucous membrane or non-intact skin expo sure with large volume/long duration, or
• Percutaneous superficial exposure with solid needle.
EC-3: Severe exposure: Percutaneous exposure with large volume.
• Injury with wide bore hollow needle visible contaminated with blood
• Transfer of large volume of blood
• Deep wound
• Injury with material used intravenous or intra-arterial procedure
Conditions when PEP is NOT recommended/ warranted:
• If source is HIV negative
• Exposed person is HIV positive
• Exposure on intact skin
• When both EC and SC are 1.
Conditions when PEP is Recommended: When any of the EC or SC is 2 or above, PEP is recommended (unless source is known HIV negative).
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