Post-exposure prophylaxis

While practising their profession, medical personnel run a real risk of accidental infection. The transmission risk from a small accidental needle stick injury is approximately 0.3%. However, the risks vary greatly according to circumstances. The risk increases considerably when large quantities of blood are inoculated or in case of a deep insertion injury. If the blood in a needle stick accident originated from a person with high viral load (in seroconversion, or if viraemia is known through monitoring or in someone with terminal AIDS), the risk is considerably higher than 1/300, increasing to 1/50 to 1/25 or even higher. After exposure through mucosa (getting a blood splash in the eye) the risk is somewhat lower. Post-exposure prophylaxis (so-called PEP) with HAART is now advised or must at least be discussed with the victim. If the risk of infection is found to be unacceptable, treatment should be started quickly (preferably within three hours, maximum delay 72 hours) with the combination Combivir®, 2 x 1 per day together with Crixivan®, Stocrin® or Viramune® (starting with 200 mg nevirapine) for 4 weeks. The combination Combivir® with Kaletra® is an alternative. If there is a high viraemia in the source patient while the latter is taking virostatic drugs and resistance can thus be expected, it is best to use a cocktail different from that used by the patient.

Summary

• PEP: if source has low viraemia so that no resistance to current medication is predicted: same medication as source

• PEP: if condition of source is unknown: Combivir® (2x 1) + Viramune® for 4 weeks.

• Alternative: (Combivir® + Stocrin®) or (Combivir® + Kaletra®)

Category: Microbiology Notes