Post-Exposure Prophylaxis (PEP)

Post-Exposure Prophylaxis (PEP)

Ways of Exposure to HIV and Hepatitis B

•    Post: After…
•    Exposure: Someone has been exposed to a disease or infection…
•    Prophylaxis: the preventing of that disease or infection
•    Post-Exposure Prophylaxis (PEP): The use of therapeutic agents to prevent infection following exposure to a pathogen

Ways of Exposure to HIV and Hepatitis B
•    Percutaneous injury (needle-stick or cut)
•    Contact of mucous membrane or non-intact skin with:
o Blood, tissue, or other bodily fluids that are potentially infectious
o Urine, sweat, and faeces only if bloody
•    For health-care workers, PEP is commonly considered for exposures to HIV and hepatitis B
•   Note that Hepatitis B is more infectious than HIV
•   If 1000 people are stuck with a needle used on a person with Hepatitis B infection,
approximately 300 of them will become infected while only about 3 0ut 1,000 people exposed with HIV may get infected.

Exposure Characteristics that Increase Risk of Transmission of HIV and
Hepatitis B

Exposure Characteristics
•   Exposure characteristics increasing risk of transmission:
         o Large quantity of blood
Device visibly contaminated with source person’s blood
       √ Procedure involving needle placed directly into source-person’s vein or artery
        √Deep injury
        o Injury with hollow-bore needle
        o Stage of HIV infection in source person
        √ Acute infection

        √Late stage
o Both stages (acute and late) are characterized by high viral load

Steps in Providing PEP in the Exposed Person
Occupational Blood Exposure
•     The following steps need to be followed when someone is exposed to HIV either percutaneous needle stick injury/cut or mucous membrane contacts the infected materials

PEP Step One: Treatment of Exposure Site
•      Wash with water and soap as soon as possible (except do not put soap in eyes)
•     Flush mucus membrane with clean water
•     Get tetanus booster if indicated
Note: Do not squeeze the wound to try to get rid of the blood.

PEP Step Two: Assess Exposure Risk
•    Worker exposed to HIV should be evaluated as soon as possible, preferably within 4 hours of exposure
o Include information on exposed persons – current medications, underlying medical conditions
•    PEP is not indicated for exposures occurring more than 72 hours ago
•    Counsel and test for HIV, HBV, and HCV
o If test is refused, PEP should not be continued
PEP Step Three: Report & Document
•    Report the accident to a senior work supervisor immediately
•    In case of a non occupational exposure, notify the proper authority
•     Complete an injury report form as soon as possible

PEP Step Four: Start PEP after Exposed Person has Consented to Start PEP
•     If HIV status of a health worker is unknown, perform HIV diagnostic testing after obtaining a person’s consent
•    Do not test discarded needles or syringes for viral contamination
•    If the source person is not known, evaluate the exposure as though it were high risk for infection
•    If the exposed person is known to be HIV positive or found to have positive result for HIV do not offer prophylaxis but refer that person to CTC
•    Starter dose/pack should be initiated within 2 hours of exposure and before testing the exposed person
•    The exposed person needs to be counselled for an HIV test
•      If the person refuses testing PEP should be discontinued

PEP Step Five: Provision of ARVs for PEP
•      A clinician can decide whether or not to start/continue the exposed person on
prophylactic treatment or whether or not to provide dual or triple therapy
•     Treatment regimen given for PEP depends on the combination of these factors:
o Magnitude of exposure
o The medical condition of the source person e.g. pregnancy
o HIV status of the exposed individual
The rate of lost to follow-up is high in this group of patients
•        Monitor for ARV drug toxicity and manage the conditions (if present) accordingly.

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