Health care workers whose activities involve contact with HIV infected patients or contact with blood or fluid from such patients, are at risk of getting infected with HIV virus. Post Exposure Prophylaxsis( PEP ) : The rationale for treating occupational HIV exposures is that antiretroviral treatment immediately after exposure to HIV may abort infection by inhibiting local HIV replication. This would allow the host’s immune defences to eradicate the virus inoculum.
The transmission of HIV infection through occupational exposure is very rare. The risk of infection percutaneous i.e through skin is 0.3%. The risk of infection after mucous membrane exposure or exposure through broken skin is much less – 0.09%
Most of the cases of occupational exposures are those with needle stick injuries. A few have been with other sharp objects such as scalpels and broken glass. A significant number of percutaneous and other blood exposures occur during surgical procedures.
Body fluids which have the potential of transmiting infection are semen, vaginal secretions, and fluids with visible blood. Exposure to saliva, tears, sweat and non bloody urine or faeces does not entail a risk of infection.
Some protective measures :
Use of two pairs of gloves by the surgeons.
Use of barriers such as face shields, impervious gowns, amd impervious shoe covers.
Treatment of Occupational Exposure to HIV
To use soap and water to wash any wound or skin that came into contact with suspected blood or fluid. Flush exposed mucous membrane with water. Do not apply caustic agents like bleach. Not to inject any antiseptic agents into the wound.
Post Exposure Prophylaxsis (PEP)
Only one agent Zidovudine is known to prevent the transmission of HIV in humans.However combination drugs are recommended. PEP is most effective if startd immediately. It should be initiated within 1-2 hours.
PEP regimens : for 28 days Zidovudine 300 mg bd. + Lamivudine 150 mg bd
If Exposure involved a high risk of transmission Indinavir800 mg qid or Nelfinavir 750 mg tid should also be added.
Those with possible exposure should undergo followup HIV antibody testing at 6 weeks, 12 weeks and at 6 months.