Recommendations for adult and pediatric prophylaxis following exposure to human immunodeficiency virus and hepatitis B and C viruses

Polo R

The aim of this review facilitate the appropriate use of prophylaxis after occupational or

nonoccupational exposure to the human immunodeficiency virus (HIV) or hepatitis B or C

viruses (HBV and HBC). The recommendations are the result of consensus among expert

panelists brought together by the office of the Spanish national secretariat for AIDS (SPNS)

and a group of scientific societies. The panel reviewed the most important current

epidemiologic and clinical studies in the literature or presented at scientific conferences and

seminars. The risk of HBV, HCV, and HIV transmission after occupational exposure depends on

the type of exposure, the serological status of the worker, the virologic status of the source,

and the time elapsed after the accident. Prophylaxis following exposure is always

recommended in cases of high or very high risk, and it is offered as an option in other cases.

Ideally, prophylaxis should be initiated within 6 hours of exposure and certainly within 72

hours. Three antiretroviral drugs are generally prescribed except in situations of very low risk,

when the use of 2 drugs might be acceptable. Treatment should be continued for at least 24

weeks. In nonoccupational exposure, the level of risk should be assessed thoroughly and the

appropriate prophylactic measure taken. Prophylaxis should always be recommended after

high-risk exposures and should be considered whenever there is appreciable risk. Once it has

been determined that the exposure was exceptional, the physician and patient should come

to an agreement regarding prophylaxis. The antiretroviral treatment protocols are the same

after occupational and nonoccupational exposures. It is very important for health care

facilities that dispense antiretroviral drugs to have risk assessment tools and action protocols

at their disposal.

Polo R