Management after HIV Occupational Exposure
HIV exposure is divided into occupational exposure and non-occupational exposure. HIV occupational exposure refers to health care workers who are at risk of HIV infection due to contact with blood, tissues or other body fluids of HIV-infected individuals in the course of their occupational work.
Exposure risk assessment
Exposure sources and their risk levels Exposure sources identified as infectious include blood, body fluids, semen and vaginal secretions. Cerebrospinal fluid, joint fluid, pleural fluid, ascites, pericardial fluid, and amniotic fluid are also infectious, but their risk of causing infection is unclear. Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomit are usually not considered infectious.
Grading of exposure source risk.
(1) Low infectious: low viral load levels, asymptomatic or high CD4 levels.
(2) Highly infectious: high viral load level, advanced AIDS, primary HIV infection, low CD4 level.
(3) Unknown exposure source status: the stage of disease in which the exposure source is located is unknown, whether the exposure source is HIV-infected, and the viral load carried by the contaminated instrument or object is unknown.
Routes of exposure and its risk The routes of occupational exposure include: the source of exposure injures the skin (stab wounds or cuts, etc.) and the source of exposure contaminates incomplete skin or mucous membranes. If the source of exposure is the blood of an HIV-infected person, then the risk of HIV infection through skin injury exposure is 0.3% and through mucous membrane exposure is 0.09%. The risk of exposure through incomplete skin is unclear and is generally considered lower than that of mucous membrane exposure. High-risk exposure factors include: high exposure, direct puncture of blood vessels by contaminated instruments, and deep tissue damage.
Exposure level grading
(1) Primary exposure: The source of exposure is body fluid or medical devices or articles containing body fluid or blood; the type of exposure is that the source of exposure is contaminated with incomplete skin or mucous membrane, but the amount of exposure is small and the exposure time is short.
(2) Secondary exposure: the exposure source is body fluids or medical devices or articles containing body fluids or blood; the exposure type is that the exposure source is contaminated with incomplete skin or mucous membranes, the exposure amount is large and the exposure time is long; or the exposure type is that the exposure source pierces or cuts the skin, but the degree of injury is mild, and it is a superficial skin abrasion or needle puncture injury (not a large hollow needle or deep puncture needle).
(3) Tertiary exposure: the exposure source is body fluid or medical equipment or articles containing body fluid or blood; the exposure type is the exposure source stabbing or cutting the skin, but the degree of injury is more serious, for deep wounds or cutting objects with obvious visible blood.
Principles of treatment after HIV occupational exposure
(1) Wash the contaminated area with soap solution and flowing water.
(2) When contaminating mucous membranes such as the eye, apply a large amount of isotonic sodium chloride solution to repeatedly flush the mucous membrane.
(3) When a wound exists, the wound should be gently squeezed to squeeze out as much blood as possible from the injury, and then flushed with soap solution and flowing water.
(4) Disinfect and dress the wound locally with 75% alcohol or 0.5% iodophor.
Prophylactic antiretroviral treatment after HIV exposure
Treatment regimen The recommended regimen is: TDF + FTC (3TC) + LPV/r or RAL.
Time to start treatment and duration of treatment
Prophylaxis should be administered as soon as possible after HIV exposure (within 2 h if possible), preferably no more than 24 h, but even if it is longer than 24 h, prophylaxis is recommended. The duration of the dosing regimen is 28 d of continuous administration.
Indications for prophylaxis
When the HIV infection status is unknown or the source of exposure is unknown, prophylaxis is usually not administered after primary exposure.
Prophylaxis is not usually administered after secondary or tertiary exposure when the HIV infection status is unknown.
Prophylaxis is usually not administered when the source of exposure is unknown.
Prophylaxis is administered if the source of exposure originates from a person at high risk for HIV.
Prophylaxis is given when there is a risk of exposure to HIV-infected individuals.
Monitoring after HIV exposure
Testing for HIV antibodies immediately, 4 weeks, 8 weeks, 12 weeks, and 6 months after HIV exposure occurred. HIV P24 antigen and HIV RNA assays are generally not recommended.
Measures to prevent occupational exposure
(1) Gloves must be worn when performing diagnostic and nursing work that may come into contact with patients’ blood and body fluids, and hands should be washed immediately after removal of gloves after operation.
(2) During medical treatment and nursing operations where splashing of blood and body fluids may occur, medical personnel should wear protective glasses in addition to gloves and masks; when there is a possibility of splashing of blood and body fluids over a large area and contamination of the operator’s body, they should also wear isolation clothing with impermeable properties.
(3) Medical personnel must wear double gloves if there is a break in the skin of the hands when performing diagnostic and nursing operations in contact with patients’ blood and body fluids.
(4) Used sharps should be placed directly into a sharps box that cannot be pierced for safe disposal; the use of vacuum blood collectors and the application of butterfly-type blood collection needles are recommended for blood draws; recapping of used disposable needles is prohibited; direct hand contact with used needles, blades and other sharps is prohibited.