Management ofPost Exposure Prophylaxis for HIV

Dr. Alap J. MehtaM.B.B.S.

Fellow in HIV Medicine ( New Delhi)Fellow in Industrial Health ( Ahmadabad)

Diploma in HIV Medicine (London, U.K.) cont..

Abbreviations

• HCP – Health Care Provider• PEP – Post Exposure Prophylaxis• OE – Occupational exposure• HIV – Human Immunodeficiency Virus• HBV – Hepatitis B Virus• HCV - Hepatitis C Virus

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Source

• New York State Guideline• CDC, Atlanta Guideline for PEP

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PrincipleNon Discrimination Confidential

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Who are at Risk• Nursing staff and students

• Laboratory technicians

• Emergency care providers

• Labour and delivery room personnel

• General Practitioner

• Physicians

• Surgeons

• Dentists

• Health facility cleaning staff and clinical waste handlers

• Interns and medical students

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Common Procedure Prone to• Recapping Needle

• Blood collection

• Intracath insertion

• Aspiration of close cavity collection

• Aspiration of abscess and lymph node

• Injecting medicine

• Intra operative (More Risk if Assisting)

• Discarding infective material etc.

• Splashes of blood/serum on face

• Transferring body fluids between containers

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Magnitude of Risk• 0.3% for HIV

• 3-10% for HCV

• 9-30% for HBV

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Fluids need consideration

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Route wise transmission of HIV

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Common C/F to suspect HIV Symptoms

• Weight Loss

• Chronic Diarrhea

• Newly diagnosed TB

• Chronic Fever

• On Chronic Therapy

• Recurrent Respiratory Illness

• Presenting complaints

Signs

• STDs

• Lymphadenopathy

• Herpes Zoster

• Herpes Labialis

• Candidacies

• Wasting

• Mollusum Contagious

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Approach to Occupational Exposure

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“S.T.U.M.P.E.D.” strategy

• S – SOURCE PATIENT• T – TYPE OF EXPOSURE• U – UNIVERSAL WORK PRECAUTION FOLLOWED• M – MATERIAL EXPOSED• P – PERIOD SINCE LAST USE OF EQUIPMENT• E – EXPOSED BEFORE• D – DESCRIPTION OF WOUNDOnline evaluation will be available shortly on my website

Most common Don’t done by HCP• Squeezing the exposed part

• sucking the exposed part

• Applies irritant disinfectant on exposed part

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Immediate StepsFor Broken or Damaged Skin•Immediately wash the wound and surrounding skin with water and soap, and rinse.•Do not scrub. •Do not use antiseptics or skin washes (bleach, chlorine, alcohol, betadine).

For Eyes:Sit in a chair, tilt head back and ask a colleague or assistant to gently pour water or normal saline over the eye.

For Unbroken Skin:•Wash the area immediately with soap and water•Do not use antiseptics

If wearing contact lens:

•leave them in place while irrigating, as they form a barrier over the eye and will help protect it. Once the eye is cleaned, remove the contact lens and clean them in the normal manner. This will make them safe to wear again•Do not use soap or disinfectant on the eye.

For Mouth :Spit fluid out immediatelyRinse the mouth thoroughly, using water or saline and spit again. Repeat this process several timesDo not use soap or disinfectant in the mouth

Steps Help a Lot• Don’t Create panic atmosphere

• Separate yourself from the site and hand over the procedure to assistant if

it requires continuation

• Don’t blame or misbehave with patients

• Call to expert after immediate step

• Become a good patient and try to complete PEP if required

• Get counsel your self from experts during PEP treatment

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Plan your Regime

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• Basic regime :Tenofovir + Emtricitabine

Expanded Regime :Basic + Lopinavir / Ritonavir or Raltegravir

Health hazards During PEP TreatmentDue to medicines

• Gastritis

• Nausea

• Vomiting

• Abdominal Pain

• Itching

• Giddiness

• Fatigue

• Malaise

• Anemia

Due to Psych-Social issues

• Re- exposure

• Depression

• Suicidal tendency

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Unique Situations• For sexually Active Life: Use barrier contraception FOR 6 MONTHS• For Pregnant Mother: Same protocol like other HCP • For Nursing Mothers: Stop breast feeding and top feed

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Laboratory Work Up

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Thank You

CENTRE OF EXCELLENCE FOR TREATMENT

OF HIV/AIDS608, KASHI PLAZA, MAJURA GATE,SURAT