Post Exposure Prophylaxis for HIV- Dr Abhimanyu Makane MBBS CHIV FHM(CMC,Vellore) AAHIVS...
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Transcript of Post Exposure Prophylaxis for HIV- Dr Abhimanyu Makane MBBS CHIV FHM(CMC,Vellore) AAHIVS...
![Page 1: Post Exposure Prophylaxis for HIV- Dr Abhimanyu Makane MBBS CHIV FHM(CMC,Vellore) AAHIVS Consultant HIV Physician Sterling Multispecialty Hospial,Nigdi,Pune.](https://reader035.fdocuments.net/reader035/viewer/2022062715/56649d835503460f94a6984e/html5/thumbnails/1.jpg)
Post Exposure Prophylaxis Post Exposure Prophylaxis for HIVfor HIV
Dr Abhimanyu MakaneMBBS CHIV FHM(CMC,Vellore) AAHIVSConsultant HIV PhysicianSterling Multispecialty Hospial,Nigdi,PuneAditya Birla Memorial Hospital,Pune
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Can someone become HIV Can someone become HIV negative after diagnosis???negative after diagnosis???Mississippi BabyThe Berlin Patients
![Page 3: Post Exposure Prophylaxis for HIV- Dr Abhimanyu Makane MBBS CHIV FHM(CMC,Vellore) AAHIVS Consultant HIV Physician Sterling Multispecialty Hospial,Nigdi,Pune.](https://reader035.fdocuments.net/reader035/viewer/2022062715/56649d835503460f94a6984e/html5/thumbnails/3.jpg)
Outline Outline Principal changes from previous
PEP guidelinesHealth care personnel and
exposureRisk of transmission of HIVRecommendations 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
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Basis of PresentationBasis of PresentationWHO Adult ARV guidelines
supplement-Dec 2014DHHS Aug 2013 PEP guidelines
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Principal Changes from Principal Changes from Previous PEP GuidelinesPrevious PEP GuidelinesElimination of risk stratification
for exposure incidents3-drug (or more) PEP regimen for
all
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Occupational Risk Exposures Occupational Risk Exposures in HCPin HCPPercutaneous
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)
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NOT Considered Infectious NOT Considered Infectious for HIV for HIV FecesNasal SecretionsSalivaSputum
Sweat TearsUrine Vomitus
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Risk of Transmission of Risk of Transmission of HIVHIV
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Assessment of the exposed Assessment of the exposed personperson4th generation ELISA for HIV HBV
◦Vaccination status
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Source Patient HIV Source Patient HIV TestingTestingIf possible, determine the HIV status of
exposure source ◦ Unknown HIV status◦ Window period
HBVHCV
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Timing and Duration of Timing and Duration of PEPPEPEffect inversely proportional to time to
initiation◦ ASAP preferably within hours◦ Point at which no benefit -not definedPEP should be taken for 4 weeks, if
tolerated◦ Appeared protective in occupational and
animal studies
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Post-exposure prophylaxis Post-exposure prophylaxis ARV regimens-for AdultsARV regimens-for AdultsTDF + 3TC (or FTC)
◦The preferred backboneRAL, LPV/r, ATV/r or DRV/r
◦Preferred third drugEFV
◦Alternative options
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ARV contraindicated as ARV contraindicated as PEPPEPNevirapine
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Special ConsiderationsSpecial ConsiderationsPregnantBreastfeedingPaediatric
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Follow-up of Exposed Follow-up of Exposed PatientPatient If 4th-generation (p24 Ag/HIV Ab test) is
used: HIV testing at baseline, 6 weeks, 12 weeks
after exposureBarrier Protection for partner protection Close follow-up to diagnose toxicities early
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Assess
Counsel &
Support
Prescriptio
n
Followup
• Clinical assessment of exposure• Eligibility assessment for HIV PEP• HIV testing of exposed people and source if possible
• Risk of HIV• Risks and benefits of HIV PEP• Adherence counselling if PEP to be prescribed
• PEP should be initiated ASAP post exposure• 28-day prescription
• HIV test at 3 months after exposure• Link to HIV treatment if possible• Provision of prevention intervention as appropriate