Post Exposure Care for HIV
HAART therapy for a month (4 weeks) must be started for any significant exposure to HIV-positive blood via needle-stick, scalpel, penetrating injury.
Also, applies to when there is exposure of mucosal surfaces to HIV-positive blood or after unprotected sexual contact with a person known to be HIV positive.
Start anti-retroviral meds. AZT & 3TC within 1 h. Add Indinavir if high exposure (advance disease, VL >50K, or with resistant organism). Give Meds. for 4 weeks.
Do a base line HIV-ab test at time of exposure. Repeat at 6 wk, 3 mo, and 6 mo. Risk of seroconversion 1:300
If prophylaxis is started 2 - 3 d post-exposure, it is of no benefit.
ELISA test: +ve >> repeat on separate sample: +ve >> Western blot confirmation: +ve = HIV inf. If Western blot is indeterminate or negative >> repeat Western blot within 3 mo.
If initial ELISA or repeat ELISA is - ve >>repeat ELISA if results are unexpected.
Dx by HIV PCR is less sensitive than antibody based testing..
Zidovudine, 200 mg tid + lamivudine, 150 mg bid x 4 weeks (Combivir).
Add either Efavirenz, 600 mg qhs, Indinavir, 800 mg, q8h, between meals. or nelfinavir, 2.5 g daily in 2-3 divided doses with meals.