• General Information On Occupational Exposure to HIV
• What to Do if an Exposure Occurs:
• Risks of HIV Infection After an Exposure
• Treatment for the Exposure
• Treatments Available
• Safety and Side Effects of Treatment
• Follow-up After Exposure
• HIV Postexposure Prophylaxis Registry
• Other Sources of Information

GENERAL INFORMATION ON OCCUPATIONAL EXPOSURES TO HIV                    GO TOP

Introduction

Health-care workers are at risk for occupational exposure to the human immunodeficiency virus (HIV). Exposures occur through needlesticks or cuts from other sharp instruments (percutaneous exposures) contaminated with an infected patient's blood or through contact of the eye, nose, or mouth (mucous membrane) or skin with a patient's blood.

Most exposures do not result in infection. The risk of infection varies with the type of exposure and factors such as:

• The amount of blood involved in the exposure
• The amount of virus in the patient's blood at the time of exposure
• Whether postexposure treatment was taken.

Your employer should have in place a system for reporting exposures in order to quickly evaluate the risk of infection from the exposure, counsel you about recommendations for treatments available to prevent infection, and monitor you for side effects of treatments and determine if infection occurs. This may involve testing your blood and that of the source patient and offering appropriate postexposure treatment.

How can occupational exposures be prevented?

Many needlesticks and other cuts can be prevented by using medical devices with safety features designed to prevent injuries by using safer techniques (e.g., not recapping needles by hand), and by disposing of used needles in appropriate sharps disposal containers. Many exposures to the eyes, nose, mouth, or skin can be prevented by using appropriate barriers (e.g., gloves, eye and face protection, gowns) when contact with blood is expected.

What should I do if I am exposed to the blood of a patient?

• Needlesticks and cuts should be washed with soap and water.

   

• Splashes to the nose, mouth, or skin should be flushed with water.

   

• Eyes should be irrigated with clean water, saline, or sterile irrigants.

No scientific evidence shows that the use of antiseptics for wound care or squeezing the wound will reduce the risk of transmission of HIV. The use of a caustic agent such as bleach is not recommended.

2.Following any blood exposure you should:

• Report the exposure to the department (e.g., occupational health, infection control) responsible for managing exposures. Prompt reporting is essential because, in some cases, HIV postexposure treatment may be recommended and it should be started as soon as possible--preferably within 1-2 hours.

   

• In addition to HIV, discuss the possible risks of acquiring hepatitis B and hepatitis C with your health care provider. You should have already received hepatitis B vaccine, which is extremely safe and effective in preventing hepatitis B.

What is the risk of HIV infection after an occupational exposure?

While the risk is very low, it is not zero. HIV infection has been reported after occupational exposures to HIV-infected blood through needlesticks or cuts; splashes in the eyes, nose, or mouth; and skin contact.

• Exposures from needlesticks or cuts cause most infections. The average risk of HIV infection after a needlestick/cut exposure to HIV-infected blood is 0.3% (i.e., three-tenths of one percent, or about 1 in 300). Stated another way, 99.7% of needlestick/cut exposures do not lead to infection.

• The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1,000).

   

• The risk after exposure of the skin to HIV-infected blood is estimated to be less than 0.1%. A small amount of blood on intact skin probably poses no risk at all. There have been no cases of HIV transmission documented due to an exposure involving a small amount of blood on intact skin. The risk may be higher if the skin is damaged (e.g., by a recent cut) or if the contact involves a large area of skin or is prolonged.

Risk from all exposures is probably increased if the exposure involves a larger volume of blood or a higher amount of HIV in the patient's blood. (Source-patients near death with AIDS or patients with symptoms of acute HIV infection usually have higher amounts of HIV in their blood.)

Is treatment available after an occupational exposure to HIV?

Yes. Results from a small number of studies suggest that the use of zidovudine (ZDV) and other antiviral drugs after certain occupational exposures may reduce the chance of HIV transmission. In one study the use of ZDV after HIV exposure from a needlestick or cut reduced the risk of HIV infection by almost 80%.

Will treatment after exposure prevent HIV infection?

These studies suggest that postexposure treatment may prevent infection with HIV. However, because there have been at least 12 reported cases of ZDV failing to prevent HIV infection in health-care workers, postexposure treatment will probably not prevent all cases of infection transmission.

Is postexposure treatment recommended for all types of occupational exposures to HIV?

No. Because most occupational exposures do not lead to HIV infection, the chance of possible serious side effects (toxicity) from the drugs used to prevent infection may be much greater than the chance of HIV infection from such exposures. Both risk of infection and possible side effects of drugs should be carefully considered when deciding whether to take postexposure treatment. Exposures with a lower infection risk may not be worth the risk of the side effects associated with these drugs.

What about exposures to blood for which the HIV status of the source person is unknown?

If the source individual cannot be identified or tested, decisions regarding follow-up should be based on the exposure risk and whether the source is likely to be a person who is HIV positive. Follow-up HIV testing should be available to all workers who are concerned about possible HIV infection through occupational exposure.

These recommendations are intended to provide guidance to clinicians and may be modified on a case-by-case basis. Whenever possible, consulting an expert with experience in the use of antiviral drugs is advised, especially if a recommended drug is not available, if the source patient's virus is likely to be resistant to one or more recommended drugs, or if the drugs are poorly tolerated.

ZDV alone may be considered for some lower risk exposures when the virus is likely to be sensitive to the drug.

Treatment should be started promptly, preferably within 1-2 hours, after the exposure. Although animal studies suggest that treatment is not effective when started more than 24-36 hours after exposure, it is not known if this time frame is the same for humans. Starting treatment after a longer period (for example, 1-2 weeks) may be considered for the highest risk exposures; even if HIV infection is not prevented, early treatment of initial HIV infection may lessen the severity of symptoms and delay the onset of AIDS.

The optimal course of treatment is unknown; because 4 weeks of ZDV appears to provide protection against HIV infection, if tolerated, treatment should probably be taken for 4 weeks.

No. The FDA has approved these drugs for the treatment of HIV infection, but not for preventing infection. However, physicians may prescribe any approved drug when, in their professional judgement, the use of the drug is warranted.

Most of the information known about the safety and side effects of these drugs is based on studies of their use in HIV-infected individuals. For these individuals, ZDV and 3TC have usually been well tolerated when taken in the doses recommended. There is less information about IDV, but it also may be well tolerated when used for a short period. IDV should not be used in combination with certain other drugs, including some prescription antihistamines (consult your health-care provider). Some of the more frequent side effects reported in HIV-infected patients include the following:

• Upset stomach (for example, nausea, vomiting, diarrhea), tiredness, or headache for people taking ZDV

   

• Upset stomach and, in rare instances, pancreatitis for people taking 3TC

   

• Jaundice and kidney stones in people taking IDV, although these side effects are infrequent when IDV is taken for less than one month. The risk of kidney stones may be reduced by drinking 48 oz of fluid per 24-hour period.

There is some information about ZDV use by health-care workers as postexposure treatment. ZDV is usually tolerated, but reported side effects have included upset stomach, tiredness, and headache, all of which stopped when the drug was stopped. There is little information on the side effects of 3TC or IDV in uninfected individuals.

Based on limited information, ZDV taken in the second and third trimesters of pregnancy has not caused serious side effects in mothers or infants. There is very little information on the safety of ZDV when taken during the first trimester or on the safety of other antiviral drugs taken during pregnancy. If you are pregnant at the time you have an occupational exposure to HIV, you should consult a physician about the use antiviral drugs for postexposure treatment.

• You should be tested for HIV antibody as soon as possible after exposure (baseline), and periodically for at least 6 months after the exposure (e.g., at 6 weeks, 12 weeks, and 6 months).

   

• If you take antiviral drugs for postexposure treatment, you should be checked for drug toxicity, including a complete blood count and kidney and liver function tests just before starting treatment and 2 weeks after starting treatment.

   

• You should report any sudden or severe flu-like illness that occurs during the follow-up period, especially if it involves fever, rash, muscle aches, tiredness, malaise, or swollen glands. Such an illness or symptoms may suggest HIV infection, drug reaction, or other medical conditions.

   

• You should contact your health-care provider if you have any questions or problems during the follow-up period.

During the follow-up period, especially the first 6-12 weeks when most infected persons are expected to show signs of infection, you should follow recommendations for preventing transmission of HIV. These include refraining from blood, semen, or organ donation and abstaining from sexual intercourse. If you choose to have sexual intercourse, using a latex condom consistently and correctly may reduce the risk of HIV transmission. In addition, women should not breast-feed infants during the follow-up period to prevent exposing their infants to HIV in breast milk.

Because information is limited about the side effects/toxicity of antiviral drugs in uninfected people, like you, the Centers for Disease Control and Prevention, Glaxo Wellcome Inc., and Merck & Co., Inc., have begun the HIV Postexposure Prophylaxis (PEP) Registry, to collect information about the safety, tolerability, and outcome of taking antiviral drugs for postexposure treatment.

If you give permission, your health-care provider will provide information to the Registry about the exposure, the antiviral drugs taken, abnormal laboratory findings, and physical symptoms associated with the use of these drugs. Participation is voluntary and confidential. No information that would identify you will be collected.

Ask your health-care provider; he or she can obtain information about the Registry by calling toll-free 1-888-PEP4HIV-(1-888-737-4448)

How can I learn more about health-care workers and occupational exposures to HIV?

Information specialists who staff the CDC National AIDS Hotline (1-800-342-2437) can answer questions or provide information on HIV infection and AIDS and the resources available in your area. The AIDS Treatment Information Service (1-800-448-0440) can also be contacted for information on the clinical treatment of HIV/AIDS. For free copies of printed material on HIV infection and AIDS, please call or write to: