Download Post Exposure Prophylaxis – NACO Guidelines

Post Exposure Prophylaxis – NACO Guidelines
Figure 1: Determination of Exposure Code (EC)
Is the source material blood, bloody fluid or other potentially infectious
material – OPIM (CSF, synovial, plural, pericardial and amniotic fluid, and
pus) or an instrument contaminated with any of these substances?
Yes
No
No PEP needed
What is the type of exposure?
Mucous membrane or
skin with integrity
compromised
Percutaneous
exposure
Intact skin
No PEP needed
What is the volume of
exposure?
Small
e.g., few drops,
small duration
EC 1
What is the severity of
exposure?
Large
Less severe
e.g., several drops,
major blood
splash, and/or
duration of several
minutes or more
e.g., solid needle,
superficial scratch
EC 2
EC 2
More severe
e.g., large bore
hollow needle,
deep puncture,
visible blood on
device, needle
used in patient’s
artery or vein
EC 3
Post Exposure Prophylaxis – NACO Guidelines
Figure 2: Determination of HIV Status Code (EC)
What is the HIV status of the exposure source?
HIV Negative
HIV Positive
Status unknown
Source unknown
No PEP
needed
Low titre
exposure
High titre
exposure
e.g. asymptomatic,
high CD4 count
e.g. advanced
AIDS, primary HIV
infection, high or
increasing viral
load, low CD4
count
HIV SC 1
HIV SC 2
HIV SC Unknown
Post Exposure Prophylaxis – NACO Guidelines
Determining PEP recommendation
EC
1
1
2
2
HIV SC
PEP Recommendation
1
PEP may not be warranted. Exposure type does
not pose a known risk for HIV transmission.
Whether the risk for drug toxicity outweighs the
benefit of PEP should be decided by the exposed
HCW and treating clinician.
2
Consider basic regimen. Exposure type poses a
negligible risk for HIV transmission. A high HIV
titre in the source may justify consideration of
PEP. Decision should be taken by the exposed
HCW and treating clinician.
1
Recommended basic regimen. Most HIV
exposures are in this category. No increased risk
for HIV transmission has been observed but use of
PEP is appropriate.
2
Recommended expanded regimen. There is an
increased risk of HIV transmission.
Unk
2/
no
3
wn
Consider basic regimen. If the source (in case of
an unknown source), and the setting where the
exposure occurred suggests a possible risk for HIV
exposure, PEP basic regimen can be considered.
Post Exposure Prophylaxis – NACO Guidelines
PEP must be initiated as soon as possible, preferably within 2
hours but not later than 72 hours.
PEP drugs should be taken for 28 days.
Basic
Regimen
• Zidovudine (AZT) – 600 mg in
divided doses (300 mg twice a
day or 200 mg thrice a day AND
• Lamivudine (3TC) – 150 mg twice
a day
Expanded
Regimen
• Basic regimen AND
• Indinavir (800 mg thrice a day) or
Nelfinavir (750 mg thrice a day)
HIV test and PEP regimen
Baseline HIV test of the HCW should be done at the time of
exposure and repeated at 6 weeks following exposure.
If second test is also negative, HIV test to be repeated 12
weeks following exposure.