Guidelines for Prophylaxis Following Occupational Exposures to HIV

Abstract

Objective: To review the latest recommendations of the Public Health Service (PHS) regarding human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) in health care workers occupationally exposed to the virus. Data Sources: MEDLINE search of the years 1985 to 1997 for the terms HIV-1 and prophylaxis. Additional articles were identified in the reference lists of articles found in the MEDLINE search. Study Selection: Clinical trials and review articles on efficacy, dosage, adverse effects, and toxicity of the various agents employed in HIV PEP. Data Extraction: Performed by the authors. Data Synthesis: Information regarding HIV PEP is limited. Controlled clinical trials usually involve small populations and are difficult to extrapolate to larger populations. PHS has reviewed the available literature and revised its recommendations for HIV PEP, and these are presented in this article. Conclusion: Until more studies are conducted, the controversy surrounding PEP therapy is likely to continue. Clinicians must continue to balance the use of PEP therapy with the overuse of antiretroviral medications so that resistance is kept to a minimum. Health care professionals must be sensitized to the issues surrounding the use of PEP therapy so that colleagues exposed to HIV on the job can receive comprehensive medical and pharmaceutical care.