HIV postexposure prophylaxis: Who should get it?

The Journal of Family Practice. 2006 July;55(7):600-604

July 1, 2006|Family Medicine

EXPOSURE ROUTE	RISK PER 10,000 EXPOSURES TO AN INFECTED SOURCE
Blood transfusion	9000
Needle-sharing injection-drug use	67
Receptive anal intercourse	50
Percutaneous needle stick	30
Receptive penile-vaginal intercourse	10
Insertive anal intercourse	6.5
Insertive penile-vaginal intercourse	5
Receptive oral intercourse^†	1
Insertive oral intercourse^†	0.5
*Estimates of risk for transmission from sexual exposures assume no condom use.
^†Source refers to oral intercourse performed on a man.
Source: Centers for Disease Control and Prevention 2005.³

TABLE 4
Recommended laboratory evaluation for nonoccupational postexposure prophylaxis of HIV infection

TEST	BASELINE	DURING PEP*	4 TO 6 WEEKS AFTER EXPOSURE	3 MONTHS AFTER EXPOSURE	6 MONTHS AFTER EXPOSURE
HIV antibody testing	E, S^†		E	E	E
Complete blood count with differential	E	E
Serum liver enzymes	E	E
Blood urea nitrogen/creatinine	E	E
Sexually transmitted diseases screen (gonorrhea, chlamydia, syphilis)	E, S	E^‡	E^‡
Hepatitis B serology	E, S		E^‡	E^‡
Hepatitis C serology	E, S			E	E
Pregnancy test (for women of reproductive age)	E	E^‡	E^‡
HIV viral load	S		E^§	E^§	E^§
HIV resistance testing	S		E^§	E^§	E^§
CD4+T lymphocyte count	S		E^§	E^§	E^§
PEP, postexposure prophylaxis; E, exposed patient; S, source.
*Other specific tests might be indicated dependent on the antiretrovirals prescribed. Literature pertaining to individual agents should be consulted.
^†HIV antibody testing of the source patient is indicated for sources of unknown serostatus.
^‡Additional testing for pregnancy, sexually transmitted diseases, and hepatitis B should be performed as clinically indicated.
^§If determined to be HIV infected on follow-up testing; perform as clinically indicated once diagnosed.

Conclusion

When there is uncertainty whether PEP is recommended, start patients on a PEP regimen while the situation is sorted out. Fortunately, joint patient-physician decision making can be assisted by the physician consultation resources mentioned previously. Keep in mind that, depending on the circumstances of the exposure, HIV transmission is only one concern among others, including infectious diseases, pregnancy, and emotional/psychological aspects resulting from the incident.

CORRESPONDENCE
Doug Campos-Outcalt, MD,MPA, 4001 North Third Street #415, Phoenix, AZ 85012. E-mail: dougco@u.arizona.edu

References

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