Post-exposure prophylaxis (PEP) involves taking antiretroviral drugs after potential exposure to HIV to prevent infection. Studies show a transmission rate of 0.33% from needlesticks and 0.09% from mucosal exposures to HIV-infected sources. Nurses and lab technicians made up most occupational transmissions. PEP drug regimens use 2-3 antiretrovirals started within 24 hours for 4 weeks. While animal studies show high protection when started early, human cases still seroconvert, indicating efficacy below 100%. Timing and duration of PEP are based on CDC and WHO guidelines.

1. PEP(Post-Exposure Prophylaxis)Dr TIN MAUNG CHITCONSULTANT PHYSICIANPGH

2. How is Post-exposure prophylaxis carried out?

3. Risk of transmissionA total of 23 studies of needle sticks among healthcare workers demonstrate HIV transmission in 20 of 6135 (0.33%) exposed to an HIV infected source.( Ann of Intern Med 1990;113;740) with mucosal surface exposure there was one transmission in 1143 exposures (0.09%) and there was no transmission in 2712 skin exposures.

4. Risk of viral transmission with sharps injury from infected source 2003 Johns Hopkins HIV guide

5. Of 56 confirmed HIV transmission in the occupational setting in USANurses 23Lab Techs 20Physicians 6Type of exposurePercutaneous 48Mucocutaneous 5Both 2MMWR June 29, 2001 / 50(RR11);1-42

6. Post exposure prophylaxis for percutaneous injury (MMWR June 29, 2001:50(RR11);1-42)

7. Drugs used for PEP2 drug combinationsZidovudine + LamivudineLamivudine + StavudineStavudine + didanosine3 Drug combinationAbove list + indinavir, nelfinavir, efavirenz, abacavir, ritonavir or lopinavir/ ritonavirMMWR June 29, 2001:50(RR11);1-42

8. Expanded regimens for PEPif source patient is already receiving ART the drug regimen for PEP will depend on what drugs the source patient is taking and the possibility of drug resistance in the source.MMWR June 29, 2001:50(RR11);1-42

9. Evidence of Efficacy of PEPanimal models: high level of protection when started within 24 hours179% reduction of transmission with zidovudine use in case-control study2two drugs, three drugs:no direct evidence that more effective than 1 drugcases of seroconversion despite 3-drug PEP imply efficacy less than 100%3,41. Tsai C-C et al. J Virol 1998;72:4265-73.2. Cardo DM et al. NEJM 1997;337:1485-90.3. Jochinsen EM et al. Arch Int Med 1999;159:2361-3.4. MMWR June 29, 2001 / 50(RR11);1-42

10. Timing of PEPMMWR June 29, 2001:50(RR11);1-42

11. Duration of PEP4 weeks (28 days) used in case-control study2 and recommended by CDC / WHO guidelines31. Tsai C-C et al. J Virol 1998;72:4265-73.2. Cardo DM et al. NEJM 1997;337:1485-90.3. MMWR June 29, 2001:50(RR11);1-42.

12. Post-Exposure Prophylaxis: Core Principles

13. THANK YOU