Management and chemoprophylaxis of occupational exposure to HIV in health-care workers

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Abstract

Exposure to blood or other at-risk body materials through percutaneous injury or contamination of mucous membranes or non-intact skin carry a risk for health care workers (HCWs) of occupationally acquiring human immunodeficiency virus (HIV) infection that has been estimated to be less than 0.5%. The management of occupational exposures to HIV is a complex and controversial issue that takes into account an intricate interplay of clinical, emotional, legal and social aspects and often indefinite scientific features. Immediately after the injury first-aid measures should be used, although no data exist to document whether this influences the risk of transmission. As soon as possible, the HCW should report the incident to the occupational medicine service in order to take active post-exposure measures and to plan an adequate follow-up. The protocol management must address several key issues, particularly counselling and providing HCWs with emotional support and including risk assessment, testing, planning and providing follow-up care. Offering post-exposure chemoprophylaxis with antiretroviral drugs, such as zidovudine and didanosine, enters into the management of occupationally exposed HCWs. Based on the current knowledge appropriate objectives of the chemoprophylaxis should be considered, i.e. reducing the rate of transmission or favourably influencing the progression of the disease. Although frequent short-term side-effects due to the prophylaxis do not appear to be an important limit, but must be monitored accurately. Further data are needed on potential long-term effects. Lack of definite efficacy data adds further frustration to the stressing situation of occupational exposure. Follow-up clinical and serological appointments should be scheduled at 6 weeks, 3 months and once more at least 6 months from the exposure. The possibility that the occupational health physician will be faced with a positive HIV test result should also be considered.

Original languageEnglish
Pages (from-to)15-32
Number of pages18
JournalBailliere's Clinical Infectious Diseases
Volume3
Issue number1
Publication statusPublished - 1996

ASJC Scopus subject areas

  • Immunology
  • Microbiology (medical)

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