Download Information on Exposure to HIV

Information on Exposure to HIV
And Antiviral Therapy
You have reported an accidental exposure to the blood or body fluids of a source known or
suspected to have HIV (Human Immunodeficiency Virus), the virus that causes AIDS. This
handout has been prepared to give you the information you will need to make some decisions—
decisions you will need to make quickly.
POSTEXPOSURE PROPHYLAXIS (PEP)
You may have heard that some workers around the country are taking medications after
occupational exposure to blood and body fluids to try to decrease the small risk of getting HIV.
Studies have suggested that taking post exposure prophylaxis may reduce the risk for HIV
transmission after occupational exposure to HIV-infected blood. The U.S. Food and Drug
Administration (FDA) has approved the marketing of several drugs for the treatment of HIV
infection. Subsequently, the Department of Public Health (DPH) in conjunction with the Centers
for Disease Control (CDC) has recommended multiple drug therapy after exposure to HIV. (1)
These recommendations stress the importance of starting post-exposure prophylaxis immediately
after an exposure. The recommended time for beginning PEP is as soon as possible, within 1-2
hours after an exposure is best, however, there may be some benefit if given within 24 hours.
RISKS AND SIDE EFFECTS OF PEP
The risks to a person taking PEP are unknown because most individuals taking the medications
are infected with HIV. However, the following is known: 1) people who are HIV positive, but
without symptoms, tolerate the drugs quite well 2) health care workers who have taken the drugs
also appear to tolerate the medication. Reported side effects include low white blood count,
anemia, headache, malaise, fatigue, nausea, diarrhea, abdominal pain, dyspepsia, nasal signs and
symptoms, cough, skin rashes, and muscle aches. The longer-term effects of PEP are unknown.
Zidovudine has been used to treat HIV-infected women during pregnancy. However,
there are no adequate and well-controlled studies of Combivir (a combination drug of both
zidovudine and lamivudine) in pregnant women. Reproduction studies with zidovudine and
lamivudine have been performed in animals. Therefore, Combivir should be used during
pregnancy only if the potential benefits outweigh the risks.
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TAKING PEP MEDICATIONS
While taking PEP, the Occupational Medicine provider will monitor your blood to see if there
are any side effects from taking the medicines and to see you for any symptoms you may be
experiencing. Appointments will be scheduled for you to follow up at the Occupational Medicine
Clinic at weeks 2, 4, 6 and months 3 and 6. It is very important to keep your appointments when
you are on antiviral therapy.
SIDE EFFECTS OF PEP
Generally, the side effects and complications of PEP include nausea, vomiting, diarrhea,
abdominal pain, dyspepsia, headaches, and fatigue. Most of the information regarding PEP is
limited to zidovudine as a single therapy and, in general, zidovudine is well tolerated. HIVinfected patients who have taken these drugs for months often develop a low red blood cell count
but this is unusual in healthy patients. These problems usually disappear when the drug is
stopped. The long-term side effects of these drugs are unknown.
If a worker is pregnant, the evaluation of risk and need for PEP should be approached as with
any other worker who has had an HIV exposure. However, the decision to use any antiviral drug
during pregnancy should involve discussion between the woman and her health-care provider
regarding the potential benefits and potential risks to her and her fetus.
TAKING THE MEDICATIONS
If the decision is made to begin the PEP medication, the first dose should be started as soon as
possible after the exposure. The next section explains dosing for two medications which may be
prescribed. Do not make any changes in the medication dose or schedule without checking with
the Occupational Medicine provider first. (FYI: changes can be made if you are not tolerating
these medications so please let us know if you are experiencing any problems). It is important to
take all the scheduled doses. Also, do not start any other medications without checking with your
Occupational Medicine provider. (see table next page)
(1) CDC, MMWR (Recommendations and Reports), May 15, 1998.
Drug:
How supplied:
Daily dose:
Dosing related to
meals:
Side effects:
Drug interactions:
Drug:
How supplied:
Daily dose:
Combivir  (lamivudine/zidovudine)
Tablet (each tablet contains: 150 mg lamivudine and 300 mg.
zidovudine)
One tablet two times per day
Take either with or without food
Neutropenia, anemia, headache, malaise, fatigue, insomnia, and
asthenia, nausea, diarrhea, abdominal pain, nasal signs and
symptoms, cough, skin rashes, muscle aches
Ganciclovir, interferon-alpha, and other bone marrow suppressive
or cytotoxic agents may increase the hemtologic toxicity of
zidovudine
Indinavir (IDV or Crixivan)
400 mg. Capsule
800 mg; take two capsules, Times: _____ am/pm
three times per day _____ am/pm
_____ am/pm
Dosing related to
meals:
Comments:
Side effects:
Drug interactions:
Take on an empty stomach. Increasing fluids while on the
medication is helpful.
Drinking six 8-oz. Glasses of water throughout the day will
decrease the incidence of nephrolithiasis (kidney stones).
Nausea, headaches, fatigue, stomach bloating, muscle aches.
nephrolithiasis, crystalluria, hematuria
Terfenadine (Seldane), astemizole (Hismanal), cisapride
(Propulsid), triazolam, midazolam, clarithromycin (Biaxin),
fluconazole (Diflucan) ketoconazole (Nizoral), quinidine, rifabutin
(Mycobutin), rifampin (Rifadin)
INFORMATION AFTER A BLOOD OR BODY FLUID EXPOSURE
You have reported an accidental exposure to blood and/or body fluids. This sheet has been
prepared to give you some important information you should be aware of related to this
exposure. Unfortunately, at a time when you may be upset that this accident has occurred, there
are several important issues you need to think about and some actions you should start
immediately.
First, you should know that it is not easy to get HIV even after a known exposure. The average
risk for HIV infection from all types of percutaneous exposures to HIV-infected blood is 3 in
1000 exposed. The risks after mucous membrane and skin exposures to HIV-infected blood are
approximately 1 in 1000 and less than 1 in 1000 respectively. Despite this low risk of acquiring
HIV, it is strongly recommended that you consider the following:
1. Sexual Activity: Safe sex practices should be followed in whatever relationships you
participate in. This would include:
a. Latex condoms should be used for all episodes of vaginal or anal intercourse. Anal
intercourse is considered a high risk practice even with the use of a condom.
b. Oral sex is less likely to transmit the virus but potentially can. Oral sex with a male
should include the use of a latex condom and oral sex with a female should be limited to
the clitoral area.
c. Transmission of the virus through saliva has not been found to exist to date.
2. Pregnancy and Family Planning: Planning to get pregnant in the period while undergoing
testing is not advised. That is because if you should turn HIV positive, the baby has a significant
chance of being infected.
3. Blood Donations: It is advised to not donate any blood for one year after the exposure.
4. Other: In general, toothbrushes, razors, or other instruments that could become contaminated
with blood should not be shared.
5. Signs and Symptoms of HIV Seroconversion: Between 6-12 weeks post exposure, you may
develop a state of viremia, e.g., when the HIV disseminates throughout the body. The signs and
symptoms are like that of the “flu” and could include night sweats, fever, chills, rash, diarrhea,
malaise, joint and/or muscle aches, swollen lymph glands and headache. If you do develop this
flu-like syndrome, please report to the Occupational Medicine site and let us know.
In conclusion and to help put this in perspective: You have had a blood and body fluid exposure.
You have not been diagnosed as having any illness but you have been exposed; and the chances
of that exposure leading to an actual disease is minimal.
Author: Jeanine Shaughnessy MSN, RN, CS, COHN-S
Approved: NEBH Clinical Practice Subcommittee, April 10, 2001