Management of Post Exposure Prophylaxis for HIV Dr. Alap J. Mehta M.B.B.S. Fellow in HIV Medicine ( New Delhi) Fellow in Industrial Health ( Ahmadabad) Diploma in HIV Medicine (London, U.K.) cont..
Abbreviations • HCP – Health Care Provider • PEP – Post Exposure Prophylaxis • OE – Occupational exposure • HIV – Human Immunodeficiency Virus • HBV – Hepatitis B Virus • HCV - Hepatitis C Virus
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Source • New York State Guideline • CDC, Atlanta Guideline for PEP
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Principle Non Discrimination
Confidential
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Who are at Risk • Nursing staff and students • Laboratory technicians • Emergency care providers • Labour and delivery room personnel • General Practitioner • Physicians • Surgeons • Dentists • Health facility cleaning staff and clinical waste handlers • Interns and medical students
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Common Procedure Prone to •
Recapping Needle
•
Blood collection
•
Intracath insertion
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Aspiration of close cavity collection
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Aspiration of abscess and lymph node
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Injecting medicine
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Intra operative (More Risk if Assisting)
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Discarding infective material etc.
•
Splashes of blood/serum on face
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Transferring body fluids between containers
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Magnitude of Risk • 0.3% for HIV
• 3-10% for HCV
• 9-30% for HBV
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Fluids need consideration
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Route wise transmission of HIV
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Common C/F to suspect HIV Symptoms
Signs
• Weight Loss
• STDs
• Chronic Diarrhea
• Lymphadenopathy
• Newly diagnosed TB
• Herpes Zoster
• Chronic Fever
• Herpes Labialis
• On Chronic Therapy
• Candidacies
• Recurrent Respiratory Illness
• Wasting
• Presenting complaints
• Mollusum Contagious
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Approach to Occupational Exposure
“S.T.U.M.P.E.D.” strategy • S – SOURCE PATIENT • T – TYPE OF EXPOSURE • U – UNIVERSAL WORK PRECAUTION FOLLOWED • M – MATERIAL EXPOSED • P – PERIOD SINCE LAST USE OF EQUIPMENT • E – EXPOSED BEFORE • D – DESCRIPTION OF WOUND Online evaluation will be available shortly on my website
Most common Don’t done by HCP • Squeezing the exposed part
•
sucking the exposed part
• Applies irritant disinfectant on exposed part
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Immediate Steps For Broken or Damaged Skin
For Eyes:
• Immediately wash the wound and surrounding skin
Sit in a chair, tilt head back and ask a colleague or
with water and soap, and rinse. • Do not scrub.
assistant to gently pour water or normal saline over the eye.
• Do not use antiseptics or skin washes (bleach, chlorine, alcohol, betadine). For Unbroken Skin:
If wearing contact lens:
• Wash the area immediately with soap and water
• leave them in place while irrigating, as they form a
• Do not use antiseptics
barrier over the eye and will help protect it. Once the eye is cleaned, remove the contact lens and clean them in the normal manner. This will make them safe to wear again • Do not use soap or disinfectant on the eye.
For Mouth : Spit fluid out immediately Rinse the mouth thoroughly, using water or saline and spit again. Repeat this process several times Do not use soap or disinfectant in the mouth
Steps Help a Lot •
Don’t Create panic atmosphere
•
Separate yourself from the site and hand over the procedure to assistant if it requires continuation
•
Don’t blame or misbehave with patients
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Call to expert after immediate step
•
Become a good patient and try to complete PEP if required
•
Get counsel your self from experts during PEP treatment
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Plan your Regime • Basic regime : Tenofovir + Emtricitabine Expanded Regime : Basic + Lopinavir / Ritonavir or Raltegravir
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Health hazards During PEP Treatment Due to medicines
Due to Psych-Social issues
• Gastritis • Nausea
• Re- exposure
• Vomiting • Abdominal Pain • Itching • Giddiness • Fatigue • Malaise • Anemia
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• Depression • Suicidal tendency
Unique Situations • For sexually Active Life: Use barrier contraception FOR 6 MONTHS • For Pregnant Mother: Same protocol like other HCP • For Nursing Mothers: Stop breast feeding and top feed
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Laboratory Work Up
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Thank You
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