HIV exposure
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At risk exposures:
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Percutaneous injury from a contaminated needlestick or sharp object (eg, scalpel)
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Mucous membrane (eg, eyes) or nonintact skin exposure to infected body fluids Types of risks:
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High risk: Blood, fluids contaminated with visible blood, semen, and vaginal secretions
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Possible risk: Cerebrospinal, synovial, pleural, pericardial, and amniotic fluids
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Low risk: Body fluids such as urine, feces, tears, and vomitus are considered noninfectious if no visible blood is present. Testing:
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The exposed patient should be tested for HIV immediately, 4 to 6 weeks later, and 3 months after the exposure. PEP:
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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.
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A two-drug regimen for postexposure prophylaxis (compared with pre-exposure prophylaxis) is no longer recommended.
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Protease inhibitors such as darunavir, whether boosted or not, are not recommended for prophylaxis because of their higher rates of adverse effects.
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Postexposure prophylaxis antiretroviral therapy has been used successfully for many years in uninfected persons to prevent infection after occupational and nonoccupational HIV exposure.
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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.
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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.