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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

New guidelines call for rapid use of at least three PEP drugs following an occupational exposure to HIV

In recently updated guidelines, the Public Health Service is recommending immediate use of a post-exposure prophylaxis (PEP) regimen containing at least three antiretroviral drugs after any occupational exposure to HIV.

The guidelines were developed by an interagency working group that included representatives from the Centers for Disease Control and Prevention, the National Institutes of Health and the Food and Drug Administration. The group worked with an expert advisory panel and the resulting recommendations are thus based on "expert opinion."

Many of the revised recommendations are intended to make a PEP regimen better tolerated, increasing the possibility that healthcare personnel will complete the full regimen of drugs. The call for at least three drugs was made in part because current PEP regimens are better tolerated than those recommended in the previously published 2005 guidelines on occupational HIV exposures. In addition, the new guidance applies to “all occupational exposures to HIV,” eliminating a 2005 recommendation to assess the level of risk associated with individual exposures to help determine the appropriate number of PEP drugs

In another change, if a newer 4th generation HIV antigen/antibody combination test is used for follow-up testing, HIV testing may be concluded at four months rather than six months after exposure.

More than three decades into the AIDS epidemic, HIV transmission from a patient to a health care worker via a needlestick remains a rare but real risk that should not be minimized, the guidelines state, noting, “ The psychological impact of needlesticks or exposure to blood or body fluid should not be underestimated.”