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 Zambia HIV National Guidelines
 


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General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents  

When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents  

Initial Regimen for ARV Therapy  

Adherence  

Baseline evaluation and Monitoring  

Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance  

ARV Therapy for Individuals with Tuberculosis Co-Infection  

Adverse Effects and Toxicity  

Immune Reconstitution Inflammatory Syndrome (IRIS)  

Changing or Stopping ART  

Treatment Failure  

Stopping ARV Therapy  

Post Exposure Prophylaxis  

Cotrimoxazole Prophylaxis  

WHO Staging in Adults and Adolescents  

Nutrition Care and Support  

Palliative Care in HIV and AIDS  

 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

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Post Exposure Prophylaxis (PEP)

03-27-2008

Risk of Acquiring HIV After Occupational Exposure

  • Low risk of HIV transmission following occupational exposure to HIV-infected blood
  • Percutaneous exposure in healthcare settings: average risk1 per 300
  • Mucocutaneous exposure: average risk < 1 in 1000
  • Blood on intact skin: no risk
  • Blood exposure also places health care workers (HCWs) at risk for other blood borne infections, such as hepatitis B and C, which are more easily transmitted than HIV. All HCWs should receive hepatitis B vaccination if available.
Factors associated with an increased risk of occupationally acquired HIV infection

  • Deep injury
  • Visible blood on device that caused injury
  • Injury with needle from artery or vein
  • Terminal HIV illness in source patient (due to high viral load)
Body fluids and materials which may pose a risk of HIV transmission

  • Amniotic fluid
  • Cerebrospinal fluid
  • Human breast milk
  • Pericardial fluid
  • Peritoneal fluid
  • Pleural fluid
  • Saliva in association with dentistry
  • Synovial fluid
  • Unfixed human tissues and organs
  • Vaginal secretions
  • Semen
  • Any other fluid if visibly bloodstained
  • Fluid from burns or skin lesions
Management of Occupational Exposures to Infectious Substances



Immediately after Exposure
  1. Clean the Exposure Site
    • If a skin wound, wash with soap and running water. If the exposed area is an eye or mucous membrane, flush with copious amounts of clean water.
    • DO NOT USE BLEACH or other caustic agents/disinfectants to clean the exposure site
  2. Contact your On Site In-Charge/ Supervisor
    • HIV/ ARV Nurse In-Charge
    • Over all Supervisor in Charge
    • Laboratory Manager
  3. Responsibilities of the Clinical Officer or Medical Officer
    • Determine if the exposure is potentially high risk based on the information in the information below
    • If exposure is considered high risk: refer to closest VCT centre IMMEDIATELY and arrange for shortened version of pre-test counselling and HIV rapid test for exposed employee. If this is likely to take longer than 1 hour, give first dose of PEP before referring.
    • Explain that all HIV testing is CONFIDENTIAL
    • Ensure the exposed employee also has a FBC and liver test (ALT) done
    • Arrange post test counseling
    • Counsel regarding post-exposure prophylaxis (PEP): risks and benefits
    • Complete the Report Form describing the details surrounding the exposure
    • Determine the need for PEP based on the nature of the exposure and the risks and benefits of taking (or not taking) antiretroviral medications.PEP should be started preferably within 1-2 hours of the exposure. If not started within 72 hours of the exposure, PEP will not be provided, as it is not likely to be effective after this time period.


  • Clean exposure site immediately with soap and running water (skin wound) or with copious amounts of clean water (eye or mucous membrane). Do not use bleach or other caustic agents/disinfectants.
  • Contact on site in-charge/supervisor
  • Responsibilities of clinical or medical officer:
  • -Determine whether exposure high risk
  • -If high risk, refer to closest VCT centre immediately, and arrange for shortened version of pre-text counseling and rapid HIV test fo exposed employee. If likely to take >1 hr, give first dose of PEP before referring.
  • -Explain that all HIV testing is confidential
  • -Perform FBC and liver test (ALT)
  • -Arrange post-test counseling
  • -Counsel regarding risk and benefits of PEP
  • -Complete Report Forum describing details of exposure
  • -Determine need for PEP based on nature of exposure and risks/benefits of taking ARVs.
  • -PEP should be started within 1-2 hrs of exposure when possible. Do not start PEP if >72 hrs of exposure, as benefit unlikely.
  • -Do not give PEP to employees who refuse HIV testing or who test positive
  • -If employee tests positive, refer to ARV clinic after adequate counseling. Observe confidentiality
Recommended Prophylaxis

  • Optimal ARV or regimen unclear, but the following are preferred:
  • No risk (intact skin): PEP not recommended
  • Medium risk (invasive injury, no blood visible on needle): AZT/3TC* + LPV/r x 28 days.
  • High risk (large volume, known HIV+ patient, hollow-bore needle, and/or deep extensive injury): same as medium risk
  • *If Hgb <10 gm/dl,use TDF/FTC instead of AZT/3TC
Management of Non-Occupational Exposure Prophylaxis

  • Substantial risk (exposure of vagina, rectum, eye, mouth or other mucous membrane, non-intact skin, or percutaneous contact with blood, semen, vaginal or rectal secretions, breast milk, or any body fluid visible contaminated with blood when source known to be HIV+):
  • <72 hrs since exposure:
  • -Source patient HIV+: nPEP recommended
  • -Source patient with unknown HIV status: case by case determination
  • >72 hrs since exposure:
  • -nPEP not recommended
  • Negligible risk (exposure of vagina, rectum, eye, mouth or other mucous membrane, intact or non-intact skin, or percutaneous contact with urine, nasal secretions, saliva, sweat or tears if not visibly contaminated with blood regardless of known or suspected HIV status of source):
  • -nPEP not recommended
  • If nPEP indicated follow recommended PEP regimens for Zambia
Follow-Up of Exposed Persons

  • Perform HIV test on day of exposure; repeat at 6 weeks, 3 months and 6 months
  • Perform HIV test if client experiences acute illness that includes fever, rash, myalgia, fatigue, malaise, and lymphadenopathy
  • Schedule evaluation by a medical or clinical officer within 72 hours after starting PEP
  • Monitoring for side effects for at least 2 weeks after starting PEP

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Zambia HIV National Guidelines

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