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New York State Department of Health
D. Counsel/treat the healthcare worker.
• Offer PEP as soon as possible following exposure,
ideally within 2 hours
• Discuss significance of exposure;
provide scientifically accurate
and not more than 36 hours after exposure.
information about the known risks of seroconversion and transmission.
• If the survivor is too distraught to engage in a discussion about
Recommendations for HIV
• Inform HCW of the need for baseline and follow-up HIV testing.
offer a first dose of medication and re-open the discussion about
Postexposure Prophylaxis (PEP)
• Encourage confidential testing
at 1, 3, and 6 months post-exposure,
treatment initiation at a follow-up visit within the next 24 hours.
New York State Department of Health AIDS Institute recommendations for
even if PEP is declined, to assess HIV status.
• Involve the rape crisis counselor
in the discussion about HIV PEP.
PEP following occupational exposure and sexual assault are based on
• Educate HCW to immediately report symptoms
• Discontinue therapy
if the perpetrator is found with certainty not to be
careful review of available studies and constitute the considered opinion of
rash, sore throat, flu-like symptoms) suggestive of acute HIV seroconversion.
expert HIV clinicians.To access the complete guidelines,visit the NYSDOH
• Counsel HCW about the need for risk reduction measures
B. HIV Testing of the Survivor:
HIV Guidelines Website at www.hivguidelines.org.
• Obtain blood for baseline HIV serologic testing
- Avoid sex or use a male latex condom or a female condom during sex.
PEP. Do not wait for results to start PEP. Refusal to undergo baseline
PEP Following Occupational Exposure
- Postpone pregnancy; consult HIV Specialist if HCW is already pregnant.
testing should not preclude initiation of therapy.
in Healthcare Workers (HCW)
- Refrain from blood, organ, or sperm donation; breast-feeding.
• Perform repeat HIV serologic testing
at 1, 3, and 6 months post-
exposure to confirm or exclude HIV infection.
A. Manage exposure incident.
Clean exposure site with soap and water;
E. Record in HCW’s confidential medical record:
date and time of
exposure; details of procedure leading to exposure including protective
C. When PEP is Initiated:
equipment used; the type, severity, and amount of fluid to which
B. Assess severity of exposure.
PEP (HAART) is recommended for all
• Schedule a follow-up visit within 24 hours
after treatment initiation
HCW was exposed; exposure source details (i.e., bloodborne diseases,
to evaluate initial tolerance of drugs and reinforce the need for regimen
ARV regimen, ARV resistance); postexposure management, including
Table 1: Assessing Significant Risk for PEP
HCW’s PEP treatment decision. OSHA requirements can be found at
• Arrange follow-up care
to monitor treatment and subsequent diag-
Type of Exposure
F. Prophylaxis for HIV exposure
• Educate the patient
to immediately report symptoms (lymphadenopathy,
• Inititiate prophylaxis as soon as possible,
ideally within 2 hours, and
rash, sore throat, flu-like symptoms) suggestive of acute HIV serocon-
no later than 36 hours postexposure
(PEP regimens on reverse side).
infectious fluid* AND
version. Instruct the patient to seek immediate medical care from an
• Treatment for 4 weeks
with all drugs is recommended.
HIV Specialist if signs or symptoms occur.
regimen and circumstances of the exposure with an HIV
• Ensure that medications are available
to the patient in sufficient sup-
within 72 hours of beginning PEP.
ply to complete a full course of PEP treatment. Various payment meth-
• Inform the HCW
about potential drug toxicity and the importance of
ods may be available, including Medicaid, Medicare, expanded Crime
* Semen, vaginal secretions, synovial, pleural, peritoneal, pericardial, cerebrospinal,
Victims Compensation or third party-payer reimbursement. For forms
• Re-evaluate HCW within 72 hours after exposure.
or victim assistance program information, visit the Crime Victims Board
C. Evaluate source patient
• Monitor HCW weekly
while on PEP regimen for adherence, symptoms
of HIV seroconversion, side effects, and emotional status.
D. Medical Care and Follow-Up:
• Do not delay initiation of PEP
to determine HIV status of the source.
• Make referrals to or consult with an HIV Specialist.
• Seek voluntary HIV testing of source
with informed consent as
• Discuss the follow-up care plan
with the rape crisis counselor or out-
PEP Following Sexual Assault
soon as possible after exposure. Rapid testing can determine HIV
status of the source patient within 30 minutes of testing. A positive
• Screen and treat for HBV, HCV, and STDs
as per NYSDOH protocol for
rapid test requires a confirmatory test.
A. Recommending PEP
(PEP regimens on reverse side):
the management of sexual assault survivors. For other recommendations,
• Evaluate for evidence of other bloodborne diseases
• Evaluate survivors of sexual assault
in a healthcare setting with
refer to the CDC 2002 Guidelines for Treatment of Sexually Transmitted
• Discontinue therapy
if the source is found with certainty not to be
access to all appropriate medical resources.
May 10, 2002 located at www.cdc.gov/STD/treatment/.
• Recommend PEP when significant exposure occurs,
as defined by
• Counsel patient regarding the need for risk reduction measures
direct contact of the vagina, anus, or mouth with the semen or
be taken until HIV, HBV, HCV, and STD infection are ruled out:
blood of the perpetrator with or without physical injury, tissue damage,
treatment on assessment of bloodborne disease risk and type
Avoid sex or use a male latex condom or a female condom during sex.
or presence of blood at the site of the assault.
Postpone pregnancy; consult HIV Specialist if survivor is pregnant.
• Recommend PEP based on the nature of the exposure,
and not the
Refrain from blood, organ or sperm donation; breast-feeding.
likelihood of HIV infection in the assailant.
HIV PEP Regimen Following Occupational Exposure
Criteria for Recommending Postexposure
Criteria for Recommending Postexposure
or Sexual Assault*†
Prophylaxis Following Occupational Exposure
Prophylaxis Following Sexual Assault
Zidovudine‡ 300 mg po bid + lamivudine 150 mg po bid
(or Combivir 1 bid)§
Tenofovir 300 mg po qd ||
* When the source is known to be HIV infected, past and current ARV therapy experi-
ence, viral load data, and genotypic or phenotypic resistance data (if available) mayindicate the use of an alternative PEP regimen. Consult an HIV Specialist.
† NNRTIs should be considered as an alternative only when 1) the HCW or sexual
assault survivor cannot tolerate either tenofovir, nelfinavir, or lopinavir/ritonavir
(co-formulated as Kaletra), or 2) when exposure has occured from a patient/
source with known drug-resistant HIV that is sensitive to the NNRTIs.
Nevirapine should be considered an alternative only when NRTIs or PIs are not an
option. Consultation with an HIV Specialist is strongly recommended. If the individual
decides to take nevirapine after a review of the risks and benefits, serum liverenzymes should be carefully monitored at baseline, weeks 2 and 4, or at any time
the patient reports significant constitutional complaints, such as fever, rash, anorexia,
or abdominal pain. The dosage for nevirapine is 200 mg po daily for the first 2 weeks,
followed by 200 mg bid for the remaining 2 weeks. Use of efavirenz should only be
Offer initial dose and reassess in 24 hours†
considered in men and women not capable of bearing children because it has been
associated with teratogenicity. Efavirenz dosage is 600 mg po qhs.
‡ If the patient is intolerant to zidovudine, stavudine 40 mg po bid may be substituted
(if patient is <60 kg, 30 mg po bid should be given).
§ The dosing interval of lamivudine should be adjusted in patients with baseline creatinine
clearance <50 mL/min. Because Combivir is a fixed-dose combination that cannot
• Recommended regimen: zidovudine 300 mg po bid +
be adjusted, zidovudine 300 mg twice daily should be combined with lamivudine
lamivudine 150 mg po bid (or Combivir 1 bid)
(dose adjusted for creatinine clearance).
|| The dosing interval of tenofovir should be adjusted in patients with baseline creati-
Tenofovir 300 mg po qd
For detailed dose adjustment recommendations, please refer to the HIV Prophylaxis
• Perform baseline confidential HIV testing of the exposed healthcare
Following Occupational Exposure chapter at www.hivguidelines.org.
worker within 72 hours of initiating HAART
• Refer to experienced clinician within 72 hours of initiating HAART
For referrals to HIV Specialists, call the AIDS Institute’s Office of the
(212) 417-4536 (M-F, 8:30-5:00); All other hours call
confirmed HIV negative
confirmed HIV positive
* Defined by direct contact of the vagina, anus or mouth with the semen or blood of the per-
NYDS HIV/AIDS Hotline:
petrator with or without physical injury, tissue damage, or presence of blood at the site of
NYSDOH protocol for management of sexual assault survivors:
† Prophylaxis should be initiated within 36 hours of the assault.
call the NYSDOH Rape Crisis Program: (518) 474-3664
‡ Complicating factors: pregnancy; other medical conditions; drug interactions.
NYSDOH HIV Guidelines Website:
§ If Specialist not available on site, 24-hour consultation information available at
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