P-443 Management of blood exposure accidents victims exposed to HIV by the occupational health department of Rabta hospital

Abstract

<h3>Introduction</h3> Post-exposure prophylaxis (PEP) reduces the risk of transmission of human immunodeficiency virus (HIV) following blood exposure accidents (BEA). However, there are no updated Tunisian recommendations for its use. <h3>Objectives</h3> To describe the circumstances of BEA requiring PEP and to evaluate the prescribing practices of PEP and clinical, biological and serological follow-up of victims. <h3>Methods</h3> We conducted a descriptive retrospective study of victims of BEA who sought medical care in the occupational medicine department of Rabta hospital in Tunis, from 1998 to 2018 and for whom a PEP was prescribed. <h3>Results</h3> A total of 456 cases were included with a median age of 30±10.3 years and a sex-ratio of 0.56. They were healthcare workers in 98% of cases, mainly physicians (35.4%), hospital porters and cleaning staff (22.3%). The most frequent tasks leading to the accidents were waste disposal (16%) and taking blood samples (10.8%). In cases of known sources (72.6%), the PEP was prescribed because the sources were HIV positive (23.6%) or had risk factors for HIV infection, mainly scarifications and/or tattoos (23.1%), drug abuse (12.9%) or history of hepatitis B and/or C (12%). In cases of unknown sources, PEP was prescribed if the BEA occurred in a suspicious socio-epidemiological context. The PEP was started within four hours of the BEA in 42.8% of cases and covered 28 days in 56.8% of cases. Poor compliance with PEP was noted in 55% of cases. The serological follow-up at one, three and six months was carried out in 11.6%, 6.5% and 4.5% of cases, respectively. Positive HIV serology of the source was significantly associated with compliance to serological follow-up at one month (p=0.023) and at three months (p=0.029). None of the cases had a seroconversion. <h3>Conclusion</h3> A well-managed PEP prevents the risk of HIV seroconversion following a BEA. It is crucial to develop a national updated guideline for management of BEA and PEP.