It is the policy of The University of Arizona Health Sciences Center that all students who are exposed (percutaneously, through mucous membranes or skin) to blood/body fluids while engaged in a University-sponsored educational program receive prompt medical attention, including counseling, prophylactic drug treatment, and baseline and follow up laboratory values, as necessary. In accordance with this policy, the following procedures must be followed by students who have been exposed to blood/body fluids.
1. To help all Arizona Health Sciences Center students who are exposed (percutaneously, through mucous membranes or skin) to blood/body fluids while participating in a University-sponsored program and to provide access to appropriate counseling, treatment, or both, and to provide follow up after such exposure, each student participating in an Arizona Health Sciences Center program shall obtain a card from the Arizona Health Sciences Center and carry it with him or her at all times while participating in such programs with the information provided below:
2. All contacts with training institutions and sites will include a provision that requires them to be familiar with the Arizona Health Sciences Center current policy on student exposure to blood/body fluids. Additionally, the institutions shall insure, upon the report of such exposure, that the University Physicians, Inc. infectious disease attending physician is contacted and shall provide or make available initial prophylactic treatment as set forth in the most recent protocols of the Centers for Disease Control within the time limit articulated within those protocols.
3. Post-exposure testing and further prophylactic drug treatment of Arizona Health Sciences Center students will be performed in Tucson.
4. The Arizona Health Sciences Center will pay for all testing and recommended prophylactic drug treatment following exposure for the period prescribed by the more recent guidelines established by the Centers for Disease Control. (http://www.cdc.gov/epo/mmwr_rr:html)
Studies of healtcare workers who ahve had occupational expsoure to HIV indicate that the risk of transmission is approximately 0.32% (Gerberding, 1996). This is not nearly as high as the risk for transmission of some other infectious diseases. For example, the risk of transmission following a single exposure to Hepatitis B is as high as 30 percent.
The risk of trnamssion is increased for expsoures involving larger amounts of blood, a deep injury, or if the source patient is in the terminal stage of HIV-related illness. The risk from mucous membrane and non-intact skin exposures is not zero, but is too low to be reliably estimated from the studies performed to date.
In December, 1995, the Centers for Disaease Control (CDC) issued a report of a study which suggested that taking zidovudine (ZDV, previously called AZT) following occupational HIV exposure reduced the risk of HIV infection by 79 percent. As a result of this new study, the use of ZDV following occupational HIV expsure can now be strongly reccommended.
In addition to taking ZDV, there are some theoretical reasons for taking a second drug, called lamivudine (3TC), to help prevent HIV transmission. The addition of 3TC might be useful fo two reasons:
A third drug, indinavir (IDV) or saquinavir (SQV) both protease inhibitors, is often added for exposures with the higest risk of HIV transmission.
The CDC and the US Public Health Service are currently recommending the following treatment as soon as possible after exposure (<2 hours) and may continue for up to 4 weeks:
Regimen |
Application |
Drug Regimen |
| Basic | Occupational HIV exposures for which there is a recognized transmission risk (based on risk factors indentified in the CDC's retrospective case-control study (Cardo et al., 1997)). | 4 wk (28d) of both zidovudine, 600 mg every day divided doses (i.e., 300 mg 2 times per d, 200 mg 3 times per d, or 100 mg very 4 hours), and lamivudine, 150mg 2 times per d. |
| Expanded | Occupational HIV exposures that pose an increased risk of transmission (e.g., larger volume of blood and/or higher virus titer in blood) (based on the presence of >2 of the risk factors identified in the case-control study (Cardo et al., 1997)) | Basic regimen plus either indinavir 800 mg every 8 h, or nelfinavir, 750 mg 3 times per d. |
Table from Henderson, 1999.
These drugs appear to be safe when taken preventively by health care workers following occupational exposure to HIV. Severe toxic reactions have been uncommon. Some risks, however, may be unforeseen.
The most common side effects of treatment are mild anemia and a lowered white blood cell count. Other fairly common adverse effects include fatigue, sleep disturbances, nausea, vomiting and headache. The following additional symptoms have been reported less frequently: fever, malaise, muscle aches, sweating, hair loss, abdominal pain, flank pain, loss of appetite, diarrhea, shortness of breath, rash and taste abnormalities, muscle or nerve inflammation, nerve conduction abnormalities, inflammation of the liver or pancreas, kidney stone formation, allergic reactions and seizures.
Some studies in mice and rats receiving very high doses of zidovudine (ZDV) have shown an increase in the incidence of vaginal cancer. No other drug related tumors were observed.
At the present time, lamivudine(3TC), indinavir (IDV), and saquinavir (SQV) are not recommended in pregnancy following occupational HIV exposures.
All health care workers, men and women, should use barrier contraception (condoms) for sexual intercourse for three months following an exposure to HIV. This is to reduce the potential for transmission of the virus to a sexual partner in the unlikely event that the exposed person does become infected with HIV. In addition, someone should use barrier contraception during this time period to avoid becoming pregnant while taking anti-HIV treatment and to reduce the chance of the drug affecting a pregnancy conceived shortly after stopping treatment. If you become pregnant while taking these medications, you must let Employee Health know immediately.
WARNINGS
None of these medications should be taken by people who have had
life threatening allergic reactions to them. The risk of serious
side effects is increased in patients who have bone marrow suppression
or severely impaired kidney or liver function. Use of anti-HIV
therapy in combination with certain other drugs can increase drug
levels and risk of toxic reactions.
No. We want to be sure you get the best medical advice but the treatment is entirely voluntary.
Only the treating physician will know. No mention of exposure and treatment will be kept in your academic record.
Prophylaxis for Occupational Exposure to HIV, J.L. Gerberding, Annals of Internal Medicine 125:497-501, 1996.
A Case-Control Study of HIV Seroconversion in Health Care Workers after Percutaneous Exposure, Cardo et al., New England Journal of Medicine 337:1485-1490, 1997.
Postexposure Chemoprophylaxis for Occupational Exposures to the Human Immunodeficiency Virus, D.K. Henderson, JAMA 281:931-936, 1999.