1. Management of Post Exposure Prophylaxis for HIV Dr. Alap J. Mehta M.B.B.S. Fellow in HIV Medicine ( New Delhi) Fellow in Industrial Health ( Ahmadabad) Diploma in HIV Medicine (London, U.K.) cont..

2. Abbreviations HCP – Health Care Provider PEP – Post Exposure Prophylaxis OE – Occupational exposure HIV – Human Immunodeficiency Virus HBV – Hepatitis B Virus HCV - Hepatitis C Virus 608, KASHI PLAZA, MAJURA GATE,SURAT

3. Source New York State Guideline CDC, Atlanta Guideline for PEP 608, KASHI PLAZA, MAJURA GATE,SURAT

4. Principle Non Discrimination Confidential 608, KASHI PLAZA, MAJURA GATE,SURAT

5. Who are at Risk Nursing staff and students Laboratory technicians Emergency care providers Labour and delivery room personnel General Practitioner Physicians Surgeons Dentists Health facility cleaning staff and clinical waste handlers Interns and medical students 608, KASHI PLAZA, MAJURA GATE,SURAT

6. Common Procedure Prone to Recapping Needle Blood collection Intracath insertion Aspiration of close cavity collection Aspiration of abscess and lymph node Injecting medicine Intra operative (More Risk if Assisting) Discarding infective material etc. Splashes of blood/serum on face Transferring body fluids between containers 608, KASHI PLAZA, MAJURA GATE,SURAT

7. Magnitude of Risk 0.3% for HIV 3-10% for HCV3-10% for HCV 9-30% for HBV 608, KASHI PLAZA, MAJURA GATE,SURAT

8. Fluids need consideration 608, KASHI PLAZA, MAJURA GATE,SURAT

9. Route wise transmission of HIV 608, KASHI PLAZA, MAJURA GATE,SURAT

10. Common C/F to suspect HIV Symptoms Weight Loss Chronic Diarrhea Newly diagnosed TB Chronic Fever On Chronic Therapy Recurrent Respiratory Illness Presenting complaints Signs STDs Lymphadenopathy Herpes Zoster Herpes Labialis Candidacies Wasting Mollusum Contagious 608, KASHI PLAZA, MAJURA GATE,SURAT

11. Approach to Occupational Exposure 608, KASHI PLAZA, MAJURA GATE,SURAT

12. “S.T.U.M.P.E.D.” strategy S – SOURCE PATIENT T – TYPE OF EXPOSURE U – UNIVERSAL WORK PRECAUTION FOLLOWED M – MATERIAL EXPOSED P – PERIOD SINCE LAST USE OF EQUIPMENT E – EXPOSED BEFORE D – DESCRIPTION OF WOUND Online evaluation will be available shortly on my website 608, KASHI PLAZA, MAJURA GATE,SURAT

13. Most common Don’t done by HCP Squeezing the exposed part sucking the exposed part Applies irritant disinfectant on exposed part 608, KASHI PLAZA, MAJURA GATE,SURAT

14. Immediate Steps For Broken or Damaged Skin Immediately wash the wound and surrounding skin with water and soap, and rinse. Do not scrub. Do not use antiseptics or skin washes (bleach, chlorine, alcohol, betadine). For Eyes: Sit in a chair, tilt head back and ask a colleague or assistant to gently pour water or normal saline over the eye. For Unbroken Skin: Wash the area immediately with soap and water Do not use antiseptics If wearing contact lens: leave them in place while irrigating, as they form a barrier over the eye and will help protect it. Once the eye is cleaned, remove the contact lens and clean them in the normal manner. This will make them safe to wear again Do not use soap or disinfectant on the eye. For Mouth : Spit fluid out immediately Rinse the mouth thoroughly, using water or saline and spit again. Repeat this process several times Do not use soap or disinfectant in the mouth 608, KASHI PLAZA, MAJURA GATE,SURAT

15. Steps Help a Lot Don’t Create panic atmosphere Separate yourself from the site and hand over the procedure to assistant if it requires continuation Don’t blame or misbehave with patients Call to expert after immediate step Become a good patient and try to complete PEP if required Get counsel your self from experts during PEP treatment 608, KASHI PLAZA, MAJURA GATE,SURAT

16. Plan your Regime Basic regime : Tenofovir + Emtricitabine Expanded Regime : Basic + Lopinavir / Ritonavir or Raltegravir

17. Health hazards During PEP Treatment Due to medicines Gastritis Nausea Vomiting Abdominal Pain Itching Giddiness Fatigue Malaise Anemia Due to Psych-Social issues Re- exposure Depression Suicidal tendency 608, KASHI PLAZA, MAJURA GATE,SURAT

18. Unique Situations For sexually Active Life: Use barrier contraception FOR 6 MONTHS For Pregnant Mother: Same protocol like other HCP For Nursing Mothers: Stop breast feeding and top feed 608, KASHI PLAZA, MAJURA GATE,SURAT

19. Laboratory Work Up 608, KASHI PLAZA, MAJURA GATE,SURAT

20. Thank You CENTRE OF EXCELLENCE FOR TREATMENT OF HIV/AIDS 608, KASHI PLAZA, MAJURA GATE,SURAT