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Postexposure Evaluation and Follow-up

Course Number: 472

Human Immunodeficiency Virus (HIV)

U.S. Public Health Service (PHS) guidelines emphasize the importance of strict adherence to (1) the principles of Standard Precautions, (2) prompt reporting of an exposure (3) expert management of occupational exposures, (4) adherence to the recommended HIV PEP regimen, and (5) follow-up of exposed HCP including careful monitoring for adverse events related to PEP and for virologic, immunologic, and serologic signs of infection.9

If the infectious status of the exposure source is unknown, he/she should be tested for serologic evidence of HIV infection. If the source person is seronegative, baseline testing and further follow-up of exposed HCP normally is not necessary. If the exposure source is unknown, the likelihood of exposure to a source at high risk is based on a determination of the risk or prevalence of HIV infection among patients in the exposure setting.

When deemed necessary, the PEP medication regimen should contain 3 (or more) antiretroviral drugs and be initiated within 72 hours (ideally within hours) of exposure.9 Initiation of PEP should not be delayed while awaiting test results. If PEP is initiated and the source person is later determined to be HIV negative, PEP should be discontinued, and no further follow-up testing is indicated for exposed HCP. If a newer 4th generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded at 4 months after exposure. Otherwise, follow-up HIV testing is typically concluded at 6 months after an HIV exposure.9

Expert counseling is recommended for those exposed to HIV, especially in cases of known or suspected pregnancy, breastfeeding, or serious medical illnesses. Those offered PEP should be provided information about possible drug toxicities and drug-drug interactions. Additional guidance should be given on how to prevent sexual transmission of HIV and about donating blood, plasma, organs, tissue, or semen during the follow-up period.

The patient-care responsibilities do not need to be modified based solely on an HIV exposure; however, they should be advised to seek medical evaluation for any acute illness that occurs during the follow-up period, especially within the first 6 to 12 weeks after exposure when most HIV-exposed persons are expected to seroconvert. If HIV seroconversion is detected, the person should be evaluated according to published recommendations for infected HCP.6,7