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Changes in post-exposure prophylaxis (PEP) are on the horizon. New, less toxic -- but possibly more expensive -- drugs are part of the regimen proposed in draft guidelines by the Centers for Disease Control and Prevention.
Improvements in HIV treatment will finally influence the follow-up of bloodborne pathogen exposures – but viral load will not be a determining factor. Although health care workers who sustain a sharps injury may feel relieved if the HIV-positive source patient has a low viral load, the guidelines will likely not recommend a different regimen in those cases, says David Kuhar, MD, medical officer with CDC’s Division of Healthcare Quality Promotion.
“If you’re exposed to a patient with an undetectable viral load, HIV can still be transmitted,” he says.
Timeliness of PEP will be emphasized in the updated guidelines, Kuhar says. Based on animal studies, “there is some consistency that delaying post-exposure prophylaxis even by a number of hours increases the risk of transmission,” he says.
Hospitals could have the three drugs available in a starter pack to make it easy for health care workers to begin PEP, he says. The new drug regimen will include emtricitibine, tenofovir and raltegravir. They will likely cost about $1,500 to $2,000 for a month’s supply, he says.
Kuhar presented draft guidelines at a recent meeting of the Healthcare Infection Control Practices Advisory Committee (HICPAC). Final guidelines are expected by late 2012 or early 2013. No confirmed cases of occupational transmission of HIV in health care workers have been reported since 1999. However, reporting of cases to CDC is not mandatory. There are two to three cases of possible occupational transmission each year, says Kuhar.