Current Infectious Disease Reports

, Volume 4, Issue 6, pp 543–549

Management of occupational and nonoccupational postexposure HIV prophylaxis

  • Mitchell H. Katz
  • Julie Louise Gerberding


The principles of managing patients with recent HIV exposure are similar whether the exposure occurs in an occupational or nonoccupational setting. For both settings, clinicians should assess the likelihood that HIV and other bloodborne viruses will be transmitted as a consequence of the exposure; advise the patient about the risks and benefits of treatment; choose an appropriate antiretroviral treatment regimen (if the decision is made to treat); screen for other illnesses that may complicate treatment or follow-up; counsel patients about the importance of adhering to treatment; promote safe-sex practices and methods to avoid future exposures; follow the patient for potential side effects of treatment; and provide follow-up care including repeat HIV testing for seroconversion, surveillance for primary HIV infection, and reinforcement of counseling messages.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Cardo DM, Culver DH, Ciesielski CA, et al.: A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med 1997, 337:1485–1490.PubMedCrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention: Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR 2001, 50(RR-11). Centers for Disease Control guidelines for management of occupational exposures.Google Scholar
  3. 3.
    Henderson DK: Postexposure chemoprophylaxis for occupational exposures to the human immunodeficiency virus. JAMA 1999, 281:931–936.PubMedCrossRefGoogle Scholar
  4. 4.
    Katz MH, Gerberding JL: Postexposure treatment of people exposed to the human immunodeficiency virus through sexual contact or injection-drug use. N Engl J Med 1997, 336:1097–1100.PubMedCrossRefGoogle Scholar
  5. 5.
    Lurie P, Miller S, Hecht F, et al.: Postexposure prophylaxis after nonoccupational HIV exposure. JAMA 1998, 280:1769–1773.PubMedCrossRefGoogle Scholar
  6. 6.
    Laporte A, Jourdan N, Bouvet E, et al.: Post-exposure prophylaxis after non-occupational HIV exposure: impact of recommendations on physicians’ experiences and attitudes. AIDS 2002, 16:397–405.PubMedCrossRefGoogle Scholar
  7. 7.
    Kinghorn GR, Evans B, Nunn A, et al.: Post-exposure prophylaxis (PEP) after non-occupational risk of HIV infection. Sex Transm Infect 1998, 74:304.PubMedGoogle Scholar
  8. 8.
    Gerberding JL: Prophylaxis for occupational exposure to HIV. Ann Intern Med 1996, 125:497–501.PubMedGoogle Scholar
  9. 9.
    DeGruttola V, Seage GR III, Mayer KH, Horsburgh CRJr: Infectiousness of HIV between male homosexual partners. J Clin Epidemiol 1989, 42:849–856.PubMedCrossRefGoogle Scholar
  10. 10.
    Wiley JA, Herschkorn SJ, Padian NS: Heterogeneity in the probability of HIV transmission per sexual contact: the case of male-to-female transmission in penile-vaginal intercourse. Stat Med 1989, 8:93–102.PubMedCrossRefGoogle Scholar
  11. 11.
    Downs AM, De Vincenzi I: Probability of heterosexual transmission of HIV: relationship to the number of unprotected sexual contacts. J Acquir Immune Defic Syndr Hum Retrovirol 1996, 11:388–395.PubMedGoogle Scholar
  12. 12.
    Peterman TA, Stoneburner RL, Allen JR, et al.: Risk of human immunodeficiency virus transmission from heterosexual adults with transfusion-associated infections. JAMA 1988, 259:55–58. [Erratum, JAMA 1989, 262:502.]PubMedCrossRefGoogle Scholar
  13. 13.
    Vittinghoff E, Douglas J, Judson F, et al.: Per-contact risk of human immunodeficiency virus transmission between male sexual partners. Am J Epidemiol 1999, 150:306–311.PubMedGoogle Scholar
  14. 14.
    Kaplan EH, Heimer R: A model-based estimate of HIV infectivity via needle sharing. J Acquir Immune Defic Syndr 1992, 5:1116–1118.PubMedGoogle Scholar
  15. 15.
    Royce R, Sena A, Cates WJ, Cohen M: Sexual transmission of HIV. N Engl J Med 1997, 336:1072–1078.PubMedCrossRefGoogle Scholar
  16. 16.
    Holmberg SD: The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. Am J Public Health 1996, 86:642–654.PubMedGoogle Scholar
  17. 17.
    Bamberger JD, Waldo CR, Gerberding JL, Katz MH: Postexposure prophylaxis for human immunodeficiency virus (HIV) infection following sexual assault. Am J Med 1999, 106:323–326. Management of postexpoxure prophylaxis following sexual assault.PubMedCrossRefGoogle Scholar
  18. 18.
    Wiebe ER, Comay SE, McGregor M, Ducceschi S: Offering HIV prophylaxis to people who have been sexually assaulted: 16 months’ experience in a sexual assault service. Can Med Assoc J 2000, 162:641–645.Google Scholar
  19. 19.
    Katz MH, Gerberding JL: Managing recent sexual exposures to HIV. Ann Intern Med 1998, 128:306–312. Comprehensive review of management of sexual exposure to HIV.PubMedGoogle Scholar
  20. 20.
    Tavares L, Roneker C, Johnston K, et al.: 3′-Azido-3′-deoxythymidine in feline leukemia virus-infected cats: a model for therapy and prophylaxis of AIDS. Cancer Res 1987, 47:3190–3194.PubMedGoogle Scholar
  21. 21.
    Mathes LE, Polas PJ, Hayes KA, et al.: Pre- and postexposure chemoprophylaxis: evidence that 3′-azido-3′-dideoxythymidine inhibits feline leukemia virus disease by a drug-induced vaccine response. Antimicrob Agents Chemother 1992, 36:2715–2721.PubMedGoogle Scholar
  22. 22.
    Ruprecht RM, O’Brien LG, Rossoni LD, Nusinoff-Lehrman S: Suppression of mouse viraemia and retroviral disease by 3′-azido-3′-deoxythymidine. Nature 1986, 323:467–469.PubMedCrossRefGoogle Scholar
  23. 23.
    Connor EM, Sperling RS, Gelber R, et al.: Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 1994, 331:1173–1180.PubMedCrossRefGoogle Scholar
  24. 24.
    Wade NA, Birkhead GS, Warren BL, et al.: Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N Engl J Med 1998, 339:1409–1414.PubMedCrossRefGoogle Scholar
  25. 25.
    Jochimsen EM: Failures of zidovudine postexposure prophylaxis. Am J Med 1997, 102:52–55.PubMedCrossRefGoogle Scholar
  26. 26.
    Kahn JO, Martin JN, Roland ME, et al.: Feasibility of postexposure prophylaxis (PEP) against human immunodeficiency virus infection after sexual or injection drug use exposure: The San Francisco PEP Study. J Infect Dis 2001, 183:707–714. Feasibility study of providing nonoccupational postexposure prophylaxis; it demonstrated that it was feasible, adherence to treatment was high, and there were no long-term side effects or seroconversions among the 401 participants.PubMedCrossRefGoogle Scholar
  27. 27.
    Centers for Disease Control and Prevention: Serious adverse events attributed to nevirapine regimens for postexposure prophylaxis after HIV exposures—worldwide, 1997–2000. MMWR 2001, 49:1153–1156.Google Scholar
  28. 28.
    Parkin JM, Murphy M, Anderson J, et al.: Tolerability and sideeffects of post-exposure prophylaxis for HIV infection. Lancet 2000, 355:722–723.PubMedCrossRefGoogle Scholar
  29. 29.
    Salomon H, Wainberg MA, Brenner B, et al.: Prevalence of HIV-1 resistant to antiretroviral drugs in 81 individuals newly infected by sexual contact or injecting drug use. AIDS 2000, 14:F17-F23.PubMedCrossRefGoogle Scholar
  30. 30.
    Brodine SK, Shaffer RA, Starkey MJ, et al.: Drug resistance patterns, genetic subtypes, clinical features, and risk factors in military personnel with HIV-1 seroconversion. Ann Intern Med 1999, 131:502–506.PubMedGoogle Scholar
  31. 31.
    Sulkowski MS, Ray SC, Thomas DL: Needlestick transmission of hepatitis C. JAMA 2002, 287:2406–2413.PubMedCrossRefGoogle Scholar
  32. 32.
    Wang SA, Panlilio AL, the HIV PEP Registry Group: Experience of health-care workers (HCWs) taking postexposure prophylaxis (PEP) after occupational human immunodeficiency virus (HIV) exposures: findings of the HIV PEP registry [abstract 127-LI-161]. In Program and Abstracts of the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego. September 1998.Google Scholar
  33. 33.
    Tokars JI, Marcus R, Culver DH, et al.: Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood. Ann Intern Med 1993, 118:913–919.PubMedGoogle Scholar
  34. 34.
    Ippolito G, Puro V: Zidovudine toxicity in uninfected healthcare workers. Italian Registry of Antiretroviral Prophylaxis. Am J Med 1997, 102:58–62.PubMedCrossRefGoogle Scholar
  35. 35.
    Tannebaum J, Anastasoff J: The role of psychosocial assessment and support in occupational exposure management. AIDS Educ Prevent 1997, 9:275–284.Google Scholar
  36. 36.
    Martin JN, Roland ME, Bamberger JD, et al.: Post-exposure prophylaxis (PEP) for sexual exposure to HIV does not lead to increases in high risk behavior: the San Francisco PEP Project. Paper presented at 8th Conference of Retroviruses and Opportunistic Infections. Chicago. February 5, 2001.Google Scholar
  37. 37.
    Desmond NM, Coker RJ: Should preventive antiretroviral treatment be offered following sexual exposure to HIV? The case for. Sex Transm Infect 1998, 74:144–145.PubMedGoogle Scholar
  38. 38.
    Evans B, Darbyshire J, Cartledge J: Should preventive antiretroviral treatment be offered following sexual exposure to HIV? Not yet! Sex Transm Infect 1998, 74:146–148.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2002

Authors and Affiliations

  • Mitchell H. Katz
    • 1
  • Julie Louise Gerberding
    • 2
  1. 1.San Francisco Department of Public HealthSan FranciscoUSA
  2. 2.Department of MedicineUniversity of California, San Franciso, San Franciso General HospitalSan FranciscoUSA

Personalised recommendations