Best practice guidelines for exposure to HIV

		Drugs recommended by the UK Department of Health as best practice for use in the prevention of HIV after a significant exposure are now available on-line to remote site medical and first aid teams and to companies looking to provide support for employees travelling to areas where HIV is particularly prevalent.

The Department of Health recommends three antiretroviral drugs for use in an HIV Post-Exposure Prophylaxis (PEP) regimen: Nelfinavir, which inhibits the process of breaking down proteins, in combination with Zidovudine and Lamivudine, all of which are available from our colleagues, medekit.com, and catalogued under anti viral drugs. The Lamivudine and Zidovudine are administered in a single Combivir tablet. Zidovudine is the only drug studied to date for which there is evidence of a reduction in the risk of HIV transmission following occupational exposure, so is proposed as the first choice for all PEP regimens.

The Government's recommendations are listed in updated guidelines from the UK Chief Medical Officer's Expert Advisory Group on Aids which contains wide reaching recommendations for heath providers as well as for organisations with employees travelling overseas.

Latest standards from the UK Department of Health confirm that, to be fully effective, post-exposure treatment for HIV should be given as soon as possible, ideally within an hour of a serious exposure incident. It's a short window of opportunity and raises the importance of the role of treatment starter packs, especially in a remote site medical situation where teams are working hours if not days from mainstream medical facilities. The guidelines suggest starter packs of recommended PEP drugs should be kept readily accessible in every Occupational Health Department.

The decision as to whether or not to offer these products to employees and how they should be administered should be fully addressed as part of a corporate occupational health protocol. The Department of Health recommends that every healthcare station should develop a post exposure policy and protocol, reflecting current best practice, which should include issues such as what defines a significant HIV exposure, where medics or employees can get sources of emergency advice and staff training. The guidelines identify the particular importance of training in the principles of this type of infection, even more so in a region where HIV infection is high.

Any health protocol should also address the issue of prevention as well as cure examining how to minimise exposure risks. Data shows that occupational exposure to HIV and other blood-borne viruses is unnecessarily common although the risk of acquiring HIV infection following exposure to HIV-infected blood in a health care setting is low, about 3 in a 1000 from an incident where contaminated blood passes through the skin, perhaps after contact with an uncovered sore or wound. Many exposures result from a failure to follow basic health and safety procedures, including the safe handling and disposal of needles and syringes or wearing protective eyewear.

The guidelines also recommend that companies should consider making seven-day starter packs of PEP drugs available to employees travelling to countries where antiretroviral therapy is not commonly available. Other measures to be considered are pre-travel briefing, reinforcing advice on post-exposure first aid measures, training on self assessment, in particular as to whether occupational exposure is significant or not and a system for getting access to immediate advice and support.

To read the full details of the Department of Health Guidelines, download a copy free at Department of Health-HIV Post-exposure prophylaxis.