Wednesday, December 26, 2012

Exposure to Blood: Treatment for the Exposure Part 2

How soon after exposure to a bloodborne pathogen should treatment start?

HBV

Postexposure treatment should begin as soon as possible after exposure, preferably within 24 hours, and no later than 7 days.

HIV

Treatment should be started as soon as possible, preferably within hours as opposed to days, after the exposure. Although animal studies suggest that treatment is less effective when started more than 24-36 hours after exposure, the time frame after which no benefit is gained in humans is not known. Starting treatment after a longer period (e.g., 1 week) may be considered for exposures that represent an increased risk of transmission.

Has the FDA approved these drugs to prevent bloodborne virus infection following an occupational exposure?

HBV

Yes. Both hepatitis B vaccine and HBIG are approved for this use.

HIV

No. The FDA has approved these drugs only for the treatment of existing HIV infection, but not as a treatment to prevent infection. However, physicians may prescribe any approved drug when, in their professional judgment, the use of the drug is warranted.

What is known about the safety and side effects of these drugs?

HBV

Hepatitis B vaccine and HBIG are very safe. There is no information that the vaccine causes any chronic illnesses. Most illnesses reported after a hepatitis B vaccination are related to other causes and not the vaccine. However, you should report to your healthcare provider any unusual reaction after a hepatitis B vaccination.

HIV

All of the antiviral drugs for treatment of HIV have been associated with side effects. The most common side effects include upset stomach (nausea, vomiting, diarrhea), tiredness, or headache. The few serious side effects that have been reported in healthcare personnel using combinations of antiviral drugs after exposure have included kidney stones, hepatitis, and suppressed blood cell production. Protease inhibitors (e.g., indinavir and nelfinavir) may interact with other medicines and cause serious side effects and should not be taken in combination with certain other drugs, such as non-sedating antihistamines, e.g., Claritin®. If you need to take antiviral drugs for an HIV exposure, it is important to tell the healthcare provider managing your exposure about any medications you are currently taking.

Can pregnant healthcare personnel take the drugs recommended for postexposure treatment?

HBV

Yes. Women who are pregnant or breast-feeding can receive the hepatitis B vaccine and/or HBIG. Pregnant women who are exposed to blood should be vaccinated against HBV infection, because infection during pregnancy can cause severe illness in the mother and a chronic infection in the newborn. The vaccine does not harm the fetus.

HIV

Pregnancy should not rule out the use of postexposure treatment when it is warranted. If you are pregnant you should understand what is known and not known regarding the potential benefits and risks associated with the use of antiviral drugs in order to make an informed decision about treatment.

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