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