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Post Exposure Prophylaxis for HIV

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Presentation on theme: "Post Exposure Prophylaxis for HIV"— Presentation transcript:

1 Post Exposure Prophylaxis for HIV
Dr Abhimanyu Makane MBBS CHIV FHM(CMC,Vellore) AAHIVS Consultant HIV Physician Sterling Multispecialty Hospial,Nigdi,Pune Aditya Birla Memorial Hospital,Pune

2 Can someone become HIV negative after diagnosis???
Mississippi Baby The Berlin Patients

3 Outline Principal changes from previous PEP guidelines
Health care personnel and exposure Risk of transmission of HIV Recommendations for the management of person potentially exposed to HIV HIV PEP Source patient testing Timing and duration of PEP Selection of PEP drugs Follow-up of exposed person Post-exposure testing Monitoring and management of PEP toxicity

4 Basis of Presentation WHO Adult ARV guidelines supplement- Dec 2014
DHHS Aug 2013 PEP guidelines

5 Principal Changes from Previous PEP Guidelines
Elimination of risk stratification for exposure incidents 3-drug (or more) PEP regimen for all

6 Occupational Risk Exposures in HCP
Percutaneous injury (needle-stick, cut) OR Contact of mucous membrane or non- intact skin WITH: Blood Tissue Other potentially infectious body fluids- (CSF, synovial, pleural, pericardial, peritoneal, or amniotic fluids; semen or vaginal secretions)

7 NOT Considered Infectious for HIV
Feces Nasal Secretions Saliva Sputum Sweat Tears Urine Vomitus

8 Risk of Transmission of HIV

9 Assessment of the exposed person
4th generation ELISA for HIV HBV Vaccination status

10 Source Patient HIV Testing
If possible, determine the HIV status of exposure source Unknown HIV status Window period HBV HCV

11 Timing and Duration of PEP
Effect inversely proportional to time to initiation ASAP preferably within hours Point at which no benefit -not defined PEP should be taken for 4 weeks, if tolerated Appeared protective in occupational and animal studies

12 Post-exposure prophylaxis ARV regimens-for Adults
TDF + 3TC (or FTC) The preferred backbone RAL, LPV/r, ATV/r or DRV/r Preferred third drug EFV Alternative options

13 ARV contraindicated as PEP

14 Special Considerations
Pregnant Breastfeeding Paediatric

15 Follow-up of Exposed Patient
If 4th-generation (p24 Ag/HIV Ab test) is used: HIV testing at baseline, 6 weeks, 12 weeks after exposure Barrier Protection for partner protection Close follow-up to diagnose toxicities early

16 Assess Prescription Followup Counsel & Support
• Clinical assessment of exposure • Eligibility assessment for HIV PEP • HIV testing of exposed people and source if possible Counsel & Support • Risk of HIV • Risks and benefits of HIV PEP • Adherence counselling if PEP to be prescribed Prescription • PEP should be initiated ASAP post exposure • 28-day prescription Followup • HIV test at 3 months after exposure • Link to HIV treatment if possible • Provision of prevention intervention as appropriate

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