If You Are Exposed to HIV: Guidelines Published for Postexposure Prevention
On May 15, 1998 the U.S. Centers for Disease Control and Prevention (CDC) published guidelines for preventive treatment of healthcare workers accidentally exposed to HIV (for example, by being stuck with a contaminated needle). While these official guidelines do not discuss persons exposed through sex or sharing needles, many experts agree that the situations are similar and the same preventive treatment should be used.The new guidelines call for four weeks of treatment, with either two drugs (AZT plus 3TC) or three drugs (AZT plus 3TC, plus either indinavir or nelfinavir). Whether to use two drugs or three--or no treatment at all--depends on the seriousness of the exposure. The guidelines include a procedure for deciding what prophylaxis is needed.
Treatment to prevent infection must be started as soon as possible, preferably within a few hours of exposure, certainly before 24-36 hours, since animal studies suggest that later treatment might not prevent infection When starting drugs immediately is not possible, the guidelines still recommend a later start in some situations, since very early treatment of HIV may be beneficial, even if it is too late to prevent the infection.
For advice in managing postexposure prophylaxis, clinicians should consult local HIV experts, or call the National Clinicians' Postexposure Hotline, 888-448-4911.
References
Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recommendations for Postexposure Prophylaxis. MMWR Recommendations and Reports, May 15, 1998; volume 47, number RR-7, pages 1-33. This publication is available at http://www.cdc.gov/mmwr/mmwrsrch.htm; or single copies may be obtained from the Centers for Disease Control and Prevention, National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20850, telephone 800-458-5231. It is also available by faxback; have the phone number of a fax machine handy, and then call 800-458-5231 and select the faxback option, which is available 24 hours a day. You can ask for a catalog of dozens of different documents, or get the postexposure prophylaxis recommendations by ordering document #3003.
Also see discussion of postexposure prophylaxis on various AIDS Web sites, including the Center for AIDS Prevention Studies (http://www.caps.ucsf.edu/PEP.html) or the Stop AIDS Project (http://www.stopaids.org/).
San Francisco has a post-exposure prevention (PEP) study, which runs a 24-hour information line at 415-502-5PEP.
