HIV Postexposure Prophylaxis Algorithm: Occupational Exposure

HIV Postexposure Prophylaxis Algorithm: Occupational Exposure
                   
  Did an exposure to a potentially HIV-infected fluid occur? No PEP not indicated; no follow-up needed.  
           
 
Yes          
       
  Did a percutaneous or other exposure occur that carries significant risk of transmission
of HIV?
 
No
PEP not indicated; no follow-up needed.  
   
 
       
 
Yes          
       
  Is the HCW presenting within 36 hours of exposure? No PEP is generally not indicated; however, follow-up evaluation and HIV testing are indicated.  
           
 
Yes          
       
  Is the source patient HIV infected as determined by rapid testing?  
No
PEP not indicated, unless the clinician suspects that there is a strong likelihood that the source has recently acquired HIV.  
   
 
       
 
Yes          
       
  Initiate PEP regimen ideally within 2 hours of exposure
• Perform baseline confidential HIV testing of the exposed healthcare worker within 72 hours of initiating PEP
• Perform baseline confidential HIV testing of the exposed healthcare worker even if worker declines PEP
• Refer to experienced clinician within 72 hours of initiating PEP
 
 
                   
       
  Source patient's serologic test is confirmed HIV negative and there is no evidence of acute retroviral syndrome in the source patient.   Source patient's serologic test is confirmed HIV negative but there has been a risk for HIV exposure in the previous 6 weeks   Serology of source patient is unable to be obtained, or source patient's serologic test is confirmed HIV positive or indeterminate, or there is evidence of acute retroviral syndrome in the source.  
                   
           
        Initiate PEP and continue until results of plasma HIV RNA assay are available.   Continue PEP for 4 weeks.  
                   
       
  Stop PEP.   Repeat HIV testing at 4 and 12 weeks   Repeat HIV testing at 4 and 12 weeks  
                   
REFERENCES

Source: New York State Department of Health. http://www.hivguidelines.org
Available at: http://www.hivguidelines.org/wp-content/uploads/2009/05/pep_card.pdf

(Rev. 4/2013)

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