Recommendations to Reduce the Risk of Occupational
HIV Transmission After an Exposure Incident

Monitoring and Side Effects

If PEP is used, drug-toxicity monitoring needs to be performed.  This should include a complete blood count and renal and hepatic chemical function tests at baseline and two weeks after starting PEP.  Monitoring for hyperglycemia should be included for PEP regimens that include a protease inhibitor.  If IDV is included in the regimen, monitoring for crystalluria, hematuria, hemolytic anemia, and hepatitis also should be performed.  If toxicity is noted, dose reduction or drug substitution should be considered with expert consultation.  Further diagnostic studies may be indicated.  Health care workers who become HIV-infected should receive appropriate medical care.  Side effects may cause difficulty with adherence to PEP.  Common symptoms associated with many of nucleoside reverse transcriptase inhibitors (NRTIs) are chiefly gastrointestinal such as nausea or diarrhea.  Other common symptoms include headache, malaise, fatigue, or insomnia.  However, serious side effects, including nephrolithiasis, hepatitis, and pancytopenia have been reported with combination PEP.  These symptoms often can be managed without changing the regimen by prescribing antimotility and antiemetic or other medications that target specific symptoms.  In other situations, modifying the dose interval, e.g., administering a lower dose more frequently throughout the day, as recommended by the manufacturer, may help promote adherence to the regimen.⁴

All the FDA-approved protease inhibitors (PI) have potentially serious drug interactions.  Therefore, careful evaluation of interactions with concomitant medications is necessary prior to prescribing a PI.

Healthcare workers often fail to complete the recommended regimen often because they experience side effects (e.g., nausea or diarrhea). These symptoms often can be managed with antimotility and antiemetic agents or other medications that target specific symptoms without changing the regimen. In other situations, modifying the dose interval (i.e., administering a lower dose of drug more frequently throughout the day, as recommended by the manufacturer) might facilitate adherence to the regimen. Serious adverse events should be reported to FDA's MedWatch program.⁴

The United States Public Health Service recommendations for PEP are intended to provide guidance to physicians.  They can be modified by local experts on a case-by-case basis.  Whenever possible, expert consultation is recommended.