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Recommendations from the U.S. Department of Health and Human Services January 2005

Antiretroviral Postexposure Prophylaxis after Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV in the United States. Recommendations from the U.S. Department of Health and Human Services January 2005. About This Presentation.

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Recommendations from the U.S. Department of Health and Human Services January 2005

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  1. Antiretroviral Postexposure Prophylaxis after Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV in the United States Recommendations from the U.S. Department of Health and Human Services January 2005

  2. About This Presentation • These slides were developed using the January 2005 recommendations. The intended audience is clinicians involved in the care of patients with HIV. • Users are cautioned that, because of the rapidly changing field of HIV care, this information could become out of date quickly. Finally, it is intended that these slides be used as prepared, without changes in either content or attribution. Users are asked to honor this intent. – AETC NRC http://www.aids-etc.org AETC National Resource Center, www.aidsetc.org

  3. Evidence of Possible Benefits from nPEP • Animal studies • Postnatal (mother-to-child) prophylaxis • Occupational PEP • Observational studies of nPEP AETC National Resource Center, www.aidsetc.org

  4. Evidence of Possible Risks from nPEP(2) • Impact on risk-reduction behaviors • ARV side effects and toxicity • Selection of resistant virus AETC National Resource Center, www.aidsetc.org

  5. Evaluationof Persons Seeking nPEP • HIV status of person seeking nPEP • Perform HIV baseline testing on persons seeking nPEP; use rapid test if possible • Time and frequency of exposure • nPEP is less likely to be effective >72 hours postexposure • nPEP should be used infrequently AETC National Resource Center, www.aidsetc.org

  6. Evaluationof Persons Seeking nPEP: HIV Status of Source • HIV status of source: HIV positive • Consider nPEP if within 72 hours of exposure • When possible, interview source to determine ARV use and most recent viral load • HIV status of source: Unknown • Determine whether source is available for testing • If source is from group with high prevalence of HIV infection, risk of transmission might be increased • Do not delay initiation of nPEP for source testing AETC National Resource Center, www.aidsetc.org

  7. Transmission Risk from the Exposure • Determine the specific sexual, injection drug use, or other behavior that led person to seek nPEP (see Estimated Per-Act Risk by Exposure Route) • Determine relative risk for HIV exposure using algorithm for evaluation and treatment and per-act risk for acquisition of HIV AETC National Resource Center, www.aidsetc.org

  8. Estimated Per-Act Risk for Acquisition of HIV by Exposure Route AETC National Resource Center, www.aidsetc.org

  9. Recommendations for Use of ARVs for nPEP AETC National Resource Center, www.aidsetc.org

  10. Negligible Risk of HIV Exposure Exposure of: vagina, rectum, eye, mouth or other mucous membrane, intact or nonintact skin, or percutaneous contact With: urine, nasal secretions, saliva, sweat, or tears if not visibly contaminated with blood Regardless of the known or suspected HIV status of the source Substantial Risk of HIV Exposure Exposure of: vagina, rectum, eye, mouth or other mucous membrane, nonintact skin, or percutaneous contact With: blood, semen, vaginal secretions, rectal secretions, breast milk, or any body fluid that is visibly contaminated with blood When the source is known to be HIV infected Assessing Risk of HIV Exposure AETC National Resource Center, www.aidsetc.org

  11. Preferred ARV Regimens for nPEP AETC National Resource Center, www.aidsetc.org

  12. Considerations for All Patients Treated with nPEP • Use starter packs • Clinicians not experienced using ART should consult with ID or other HIV-care specialists • Facilitate adherence • Monitor for signs and symptoms associated with acute infection • Follow-up HIV tests at 4-6 weeks, 3 months, and 6 months to determine whether infection has occurred • Screening for STDs, hepatitis B and C, and pregnancy should be offered • HIV prevention counseling • Reporting and confidentiality AETC National Resource Center, www.aidsetc.org

  13. Lab Evaluations for nPEP E = exposed patient; S = source patient AETC National Resource Center, www.aidsetc.org

  14. Lab Evaluations for nPEP (2) AETC National Resource Center, www.aidsetc.org

  15. Special Considerations for Vulnerable Populations • Pregnant women and women of childbearing potential • Children • Sexual assault survivors • Inmates • Injection drug users AETC National Resource Center, www.aidsetc.org

  16. About This Slide Set • This presentation was prepared by Mark Vogel, MA, for the AETC National Resource Center in January 2005 • See the AETC NRC website for the most current version of this presentation: http://www.aids-etc.org AETC National Resource Center, www.aidsetc.org

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