The document describes three consultation services provided by the National HIV/AIDS Clinicians' Consultation Center: Warmline, PEPline, and the Perinatal HIV Hotline. Warmline provides expert consultation on all aspects of HIV care and testing. PEPline provides recommendations on managing occupational and non-occupational exposures to HIV, hepatitis B, and hepatitis C. The Perinatal HIV Hotline provides advice on testing and care of HIV-infected pregnant women and their infants, as well as referrals. The consultation services are free of charge and staffed by physicians, clinical pharmacists, and other experts.

1. Warmline, PEPline, Perinatal
Telephone Consultation Service
NATIONAL HIV/AIDS CLINICIANS’ CONSULTATION CENTER
WARMLINE, PEPLINE AND PERINATAL HIV HOTLINE
JASON TOKUMOTO, MD
Assistant Clinical Professor of Medicine
UNIVERSITY OF CALIFORNIA SAN FRANCISCO
DISCLOSURE: DR TOKUMOTO HAS NO FINANCIAL INTERESTS OR RELATIONSHIPS WITH COMMERCIAL ENTITIES WHOSE
PRODUCTS OR SERVICES ARE RELEVANT TO THE CONTENT OF HIS PRESENTATION.

2. National HIV/AIDS Clinicians’ Consultation Center
UCSF – San Francisco General Hospital
www.nccc.ucsf.edu
WARMLINE 800.933.3413 NATIONAL HIV TELEPHONE CONSULTATION SERVICE
CONSULTATION ON ALL ASPECTS OF HIV CARE AND TESTING
PEPLINE 888.448.4911 NATIONAL CLINICIANS’ POST-EXPOSURE PROPHYLAXIS HOTLINE
RECOMMENDATIONS ON MANAGING OCCUPATIONAL(AND NON)EXPOSURES TO
HIV AND HEPATITIS B & C
PERINATAL HIV HOTLINE 888.448.8765 NATIONAL PERINATAL HIV CONSULTATION AND
REFERRAL SERVICE
ADVICE ON TESTING AND CARE OF HIV-INFECTED PREGNANT WOMEN
ANDTHEIR INFANT. REFERRALS TO HIV-EXPERIENCED CLINICANS AND REGIONAL
RESOURCES
HRSA AIDS Education and Training Centers (AETC) Program, HIV/AIDS Bureau
& HRSA Community Based Programs
with additional funding from Centers for Disease Control and Prevention (CDC)

4. National Clinicians’ Consultation Center (NCCC)
Warmline, PEPline and Perinatal Hotline
Physicians
Internal Medicine
Infectious Diseases
Family Medicine
Ob-Gyn
Clinical Pharmacists
-------------------------------------------
Expert consultation, free of
charge

5. Consultations Provided by the NCCC
Total – 170,000 calls
2011 volume
Warmline (1992) 3585
PEPline (1997) 9678
Perinatal HIV Hotline (2004) 385
Total 2011 14,356
(1200/mo)

6. HIV+ Patient Load of Warmline Callers
Warmline Caller's HIV+ Case Load
300
Number of Patients
250
200
150
100
50
0
0 1-3 4-10 11-25 26-50 51- 101+
100
Case Load Categories

7. Profession of Warmline Callers
Profession of Warmline Percentage
Callers
MD/DO 66.2%
NP/PA 14.8%
RN/LVN 5.6%
Other Medical 4.3%
Pharmacist (PharmD/RPh) 5.3%
Other Nonmedical 1.2%
Dental 0.5%
Unknown 2.0%

8. Facility of Warmline Callers
Facility of Warmline Callers Percentage
Community Clinic/Migrant 34.5%
Health Center
Private Practice/Ambulatory 18.9%
Hospital 15.7%
Nonmedical 4.1%
Outpatient - Other 13.4%
Other Medical/Dental 7.9%
Unknown 5.4%

9. Warmline Call Topics
Warmline Call Topics Percentage
Drug Treatment Strategies 62.9%
Clinical & Laboratory 10.8%
Abnormalities
Management of HIV-related 12.5%
Conditions
Referrals & References 2.9%
Primary Care & Epidemiology 2.8%
Testing & Counseling 5.1%
Transmission & Prevention 2.8%

10. Warmline
 Provide timely, state-of-the-art, evidence-based, and
accurate consultation.
 Latest DHHS/CDC guidelines.
 Group consulting.
 Specialty consultation.
 Options.
 Improve consultation technique.
 “Meet caller at where he/she is.”
 Question behind the question.
10

11. Warmline question-antiretrovirals
 What antiretroviral regimen? (First regimen –
resistant virus)
 Obtain antiretroviral history.
 Request fax of all resistance tests results.
 Adherence.
 What patient can and will take and do.
 Liver function and renal function.
 Other medications.
 Provide options.
11

12. Warmline – testing question
 20 week pregnant female with no risk factors for HIV
undergoes HIV screening test with a 4th generation
HIV ½ test(tests for both HIV ab and P24 antigens).
 Test is positive, WB indeterminate, P24
indeterminate.
 One week later, retested. Test is again positive with
an indeterminate WB; P24 antigen positive with
RNA PCR and DNA PCR undetectable.
 At 35 weeks, remains positive for the 4th generation
test with an indeterminate WB(same bands) and P24
indeterminate.
12

13. PEPline 888.448.4911
Managing Occupational and Non-Occupational Exposures to Bloodborne Pathogens
Steps in Managing BBP Exposures
Assess risk:
 nature of injury and type of fluid
 source patient factors
Determine whether to offer PEP
Select PEP regimen
Obtain baseline laboratory tests
Counsel the HCW and/or treating clinician
Follow-up care

14. Caller
Treating Clinician 72%
Caller is exposed 14%
Other 14%
0 1000 2000 3000 4000 5000 6000 7000
Caller Profession
MD 42%
RN/NP/PA/CNM/LVN 45%
Other/Unknown 13%
0 500 1000 1500 2000 2500 3000 3500 4000

15. Profession of the Exposed
MD 16%
RN/NP/PA/CNM/LVN 64%
Other/Unknown 20%
0 200 400 600 800 1000 1200
Exposure Setting
Hospital 26%
ED 5%
OR/L&D/Procedure 10%
Outpt/Other Medical 20%
Dental/Lab/Ambulance/other 38%
0 500 1000 1500 2000 2500 3000 3500

16. Exposure Category
Percutaneous 64%
Mucous Membrane 20%
Cutaneous 16%
0 1000 2000 3000 4000 5000 6000
Exposure Fluid
Blood 56%
Saliva 16%
Other/Unknown 28%
0 1000 2000 3000 4000 5000

17. PEPline
No occupational transmission of HIV since 2001.
 Documented US occupational HIV transmission remains at
56.
 Another 138 possible US occupational HIV transmission.
17

18. Perinatal
1. Prenatal HIV antiretroviral regimens.
2. Intrapartum issues e.g. rupture membranes, mode
of delivery.
3. Antiretrovirals(PEP) for the infant.
4. Ruling out HIV in the infant born to an HIV +
mother.
Work very closely with the HIV ob-gyn specialist.
18