The U.S. Department of Health and Human Services (DHHS) Working Group on Nonoccupational Postexposure Prophylaxis (nPEP) has extended the recommended use of antiretroviral postexposure prophylaxis (PEP) beyond health-care workers at risk for infection due to occupational exposure (e.g., needle-sticks). PEP is now recommended for anyone who experiences unanticipated, nonoccupational exposure to HIV (e.g., accident, sexual assault, isolated incidents of unprotected sex or needle-sharing).
The following recommendations are intended for the United States alone, as they might not apply in other countries:
For persons seeking care < 72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person known to be HIV infected, when that exposure represents a substantial risk for transmission, a 28-day course of highly active antiretroviral therapy (HAART) is recommended. Antiretroviral medications should be initiated as soon as possible after exposure.
For persons seeking care < 72 hours after nonoccupational exposure to blood, genital secretions, or other potentially infectious body fluids of a person of unknown HIV status, when such exposure would represent a substantial risk for transmission if the source were HIV infected, no recommendations are made for the use of nPEP. Clinicians should evaluate risks and benefits of nPEP on a case-by-case basis.
For persons with exposure histories that represent no substantial risk for HIV transmission or who seek care > 72 hours after exposure, DHHS does not recommend the use of nPEP. Clinicians might consider prescribing nPEP for exposures conferring a serious risk for transmission, even if the person seeks care > 72 hours after exposure if, in their judgment, the diminished potential benefit of nPEP outweighs the risks for transmission and adverse events.
For all exposures, other health risks resulting from the exposure should be considered and prophylaxis administered when indicated. Risk-reduction counseling and indicated intervention services should be provided to reduce the risk for recurrent exposures. (p. 1)
Reference
Centers for Disease Control and Prevention. (2005). Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States : Recommendations from the U.S. Department of Health and Human Services. Morbidity & Mortality Weekly Report, 54 (RR02), 1-20.
- Compiled by Abraham Feingold, Psy.D.
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Spring 2005 Newsletter
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