Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis.
Abstract
This report updates US Public Health Service recommendations for the management of healthcare personnel (HCP) who experience occupational exposure to blood and/or other body fluids that might contain human immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis (PEP) regimens and the duration of HIV follow-up testing for exposed personnel have been updated. This report emphasizes the importance of primary prevention strategies, the prompt reporting and management of occupational exposures, adherence to recommended HIV PEP regimens when indicated for an exposure, expert consultation in management of exposures, follow-up of exposed HCP to improve adherence to PEP, and careful monitoring for adverse events related to treatment, as well as for virologic, immunologic, and serologic signs of infection. To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns, and institutions should take steps to ensure that staff are aware of both the importance of and the institutional mechanisms available for reporting and seeking care for such exposures. The following is a summary of recommendations: (1) PEP is recommended when occupational exposures to HIV occur; (2) the HIV status of the exposure source patient should be determined, if possible, to guide need for HIV PEP; (3) PEP medication regimens should be started as soon as possible after occupational exposure to HIV, and they should be continued for a 4-week duration; (4) new recommendation-PEP medication regimens should contain 3 (or more) antiretroviral drugs (listed in Appendix A ) for all occupational exposures to HIV; (5) expert consultation is recommended for any occupational exposures to HIV and at a minimum for situations described in Box 1 ; (6) close follow-up for exposed personnel ( Box 2 ) should be provided that includes counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity; follow-up appointments should begin within 72 hours of an HIV exposure; and (7) new recommendation-if a newer fourth-generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded 4 months after exposure ( Box 2 ); if a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after an HIV exposure.
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Severe adverse effects are rare from PEP.
“Providers should emphasize that severe adverse effects are rare from PEP (1431–1435).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [1431]
The sections on PEP toxicity say that side effects are often manageable and recommend monitoring for serious adverse effects, but they do not state how often severe effects occur. A search for the frequency of severe or serious PEP adverse effects found no passage establishing that they are rare. (LLM, conf=0.72)
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- Authors
- Kuhar, D. T., Henderson, D. K., Struble, K. A., Heneine, W., Thomas, V., Cheever, L. W., Gomaa, A., Panlilio, A. L., & US Public Health Service Working Group
- Affiliations
- Centers for Disease Control and Prevention (US)
- National Institutes of Health (US)
- United States Food and Drug Administration (US)
- Health Resources and Services Administration (US)
- Corresponding author
- Kuhar, David T.
- Venue
- Infection Control & Hospital Epidemiology
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-09
- Volume
- 34
- Issue
- 9
- Pages
- 875-892
- ISSN
- 0899-823X (ISSN-L)
- 1559-6834
- OpenAlex
- W2121551893
- Cited by
- 377
- References
- 74
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 18 · 2023: 22 · 2022: 17 · 2021: 20 · 2020: 22 · 2019: 28 · 2018: 29 · 2017: 37 · 2016: 58 · 2015: 48 · 2014: 37 · 2013: 9
- FWCI
- 36.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Infection Control and Hospital Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bristol-Myers Squibb
- GlaxoSmithKline
- Gilead Sciences
- National Institutes of Health
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Keywords
- occupational HIV exposure, healthcare workers, post-exposure prophylaxis, HIV prevention, antiretroviral therapy, exposure reporting, drug toxicity monitoring, primary prevention
- MeSH terms
- Emergency Medicine, Female, Health Personnel, Humans, Occupational Diseases, Pregnancy, Risk Factors, HIV Infections, Occupational Exposure, Anti-HIV Agents, Post-Exposure Prophylaxis
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