HIV exposure

At risk exposures:

  • Percutaneous injury from a contaminated needlestick or sharp object (eg, scalpel)

  • Mucous membrane (eg, eyes) or nonintact skin exposure to infected body fluids Types of risks:

  • High risk: Blood, fluids contaminated with visible blood, semen, and vaginal secretions

  • Possible risk: Cerebrospinal, synovial, pleural, pericardial, and amniotic fluids

  • Low risk: Body fluids such as urine, feces, tears, and vomitus are considered noninfectious if no visible blood is present. Testing:

  • The exposed patient should be tested for HIV immediately, 4 to 6 weeks later, and 3 months after the exposure. PEP:

  • Generally, 3 drug PEP (tenofovir, emtricitabine, and dolutegravir) is offered to patients with any risk of occupational transmission as guided by exposure type and body fluid involved.

  • A two-drug regimen for postexposure prophylaxis (compared with pre-exposure prophylaxis) is no longer recommended.

  • Protease inhibitors such as darunavir, whether boosted or not, are not recommended for prophylaxis because of their higher rates of adverse effects.

  • Postexposure prophylaxis antiretroviral therapy has been used successfully for many years in uninfected persons to prevent infection after occupational and nonoccupational HIV exposure.

  • Prophylaxis should be started as soon as possible after exposure; it is not recommended if more than 72 hours have passed. A three-drug regimen is given for 4 weeks; the preferred regimen is tenofovir disoproxil fumarate and emtricitabine plus either raltegravir or dolutegravir.

  • HIV testing of the exposed person should be conducted at baseline and at 4 to 6 weeks and 3 months after exposure. Figure 22 shows an algorithm for evaluation of possible HIV exposure.