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

Use of PEP When HIV Infection Status of Source Person is Unknown

If the source person’s HIV infection status is unknown at the time of exposure, use of PEP should be decided on a case-by-case basis, after considering the type of exposure and the clinical and/or epidemiologic likelihood of HIV infection in the source (Tables 1 and 2).  If these considerations suggest a possibility for HIV transmission, then initiating a two-drug regimen is recommended.  Once the source’s HIV test results are obtained, the need for PEP and medications can be reevaluated.  The following are recommendations regarding HIV postexposure prophylaxis:

• If indicated, start PEP as soon as possible after an exposure.
• Reevaluation of the exposed person should be considered within 72 hours postexposure, especially as additional information about the exposure or source person becomes available.
• Administer PEP for 4 weeks, if tolerated.
• If a source person is determined to be HIV-negative, PEP should be discontinued.⁴

PEP for Pregnant Health Care Workers

If the exposed person is pregnant, the evaluation of risk of infection and need for PEP should be approached as with any other person who has had an HIV exposure.  However, the decision to use any antiretroviral drug during pregnancy should involve discussion between the woman and her health care provider(s) regarding the potential benefits and risks to her and her fetus.⁴

Certain drugs should be avoided in pregnant women.  Because teratogenic effects were observed in primate studies, (efavirenz) EFV is not recommended during pregnancy.  Reports of fatal lactic acidosis in pregnant women treated with a combination of d4T and ddl have prompted warnings about these drugs during pregnancy.  Because of the risk of hyperbilirubinemia in newborns, indinavir (IDV) should not be administered to pregnant women shortly before delivery.⁴