Article ContentsCCOE OnlineUMDNJ Resources | Recommendations to Reduce the Risk of Occupational
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| Exposure type | HIV-positive class 1* |
HIV-positive class 2* |
Source of unknown HIV status ~ |
Unknown source^ |
HIV-negative |
Less severe << |
Recommend basic 2-drug PEP |
Recommend expanded 3-drug PEP |
Generally, no PEP warranted, however consider basic 2-drug PEP** for source with HIV risk factors ++ |
Generally, no PEP warranted, however consider basic 2-drug PEP** in settings where exposure to HIV-infected persons is likely |
No PEP warranted |
More severe >> |
Recommend expanded 3-drug PEP |
Recommended expanded 3-drug PEP |
Generally, no PEP warranted, however consider basic 2-drug PEP** for source with HIV risk factors++ |
Generally, no PEP warranted, however consider basic 2-drug PEP** in settings where exposure to HIV-infected persons is likely |
No PEP warranted |
* HIV positive, Class 1 - asymptomatic HIV infection or known low viral load (e.g., <1,500 rna copies/mL). HIV positive, Class 2 - symptomatic HIV infection, AIDS, acute serocoversion, or known high viral load. If drug resistance is a concern, obtain expert consultation. Initiation of postexposure prophylaxis (pep) should not be delayed pending expert consultation, and, because expert consultation alone cannot substitute for face-to-face counseling, resources should be available to provide immediate evaluation and follow-up care for all exposures.
~ Source of unknown HIV status (e.g., deceased source person with no samples available for HIV testing).
^ Unknown source (e.g., a needle from a sharps disposal container).
<< Less severe (e.g., solid needle or superficial injury).
** The designation “consider PEP” indicates that PEP is optional and should be based on an individualized decision between the exposed person and the treating clinician.
++ If PEP is offered and taken and the source is later determined to be HIV negative, PEP should be discontinued.
>> More severe (e.g., large-bore hollow needle, deep puncture, visible blood on device, or needle used in patient’s artery or vein).
Table 2. Recommended HIV Postexposure Prophylaxis for Mucous Membrane Exposures and Nonintact Skin£ Exposures
Infection status of source
Exposure type |
HIV-positive class 1* |
HIV-positive class 2* |
Source of unknown HIV status ~ |
Unknown source # |
HIV-negative |
Small volume ^ |
Consider basic 2-drug PEP~~ |
Recommend expanded 3-drug PEP |
Generally, no PEP warranted ++ |
Generally, no PEP warranted |
No PEP warranted |
Large volume Ø |
Recommend expanded 3-drug PEP |
Recommended expanded 3-drug PEP |
Generally, no PEP warranted, however consider basic 2-drug PEP** for source with HIV risk factors ++ |
Generally, no PEP warranted, however consider basic 2-drug PEP** in settings where exposure to HIV-infected persons is likely |
No PEP warranted |
£ For skin exposures, follow-up is indicated only if there is evidence of compromised skin integrity (e.g., dermatitis, abrasion, or open wound).
* HIV positive, Class 1—asymptomatic HIV infection or known low viral load (e.g., <1,500 rna copies/mL). HIV-Positive, Class 2 - symptomatic HIV infection, AIDS, acute serocoversion, or known high viral load. If drug resistance is a concern, obtain expert consultation. Initiation of postexposure prophylaxis (pep) should not be delayed pending expert consultation, and, because expert consultation alone cannot substitute for face-to-face counseling, resources should be available to provide immediate evaluation and follow-up care for all exposures.
~ Source of unknown HIV status (e.g., deceased source person with no samples available for HIV testing)
# Unknown source (e.g., splash from inappropriately disposed blood).
^ Small volume (e.g., a few drops).
** The designation “consider PEP” indicates that PEP is optional and should be an individualized decision between the exposed person and the treating clinician.
++ If PEP is offered and taken and the source is later determined to be HIV-negative, PEP should be discontinued.
