Antiretroviral post-exposure prophylaxis (PEP) for occupational HIV exposure

This review evaluated the effects of antiretroviral post-exposure prophylaxis (PEP) for preventing HIV infection following occupational exposure. No randomized controlled trials were identified. Only one case-control study provides evidence for using zidovudine monotherapy. The study found that, in the occupational setting, HIV transmission was significantly associated with deep injury, visible blood on the sharp instrument, procedures involving a needle placed in the source patient's blood vessel, and terminal illness in the source patient. After taking these into account, it was found that those who became infected with HIV had significantly lower odds of having taken zidovudine after exposure, compared to those who did not seroconvert. There is no direct evidence to support the use of multi-drug antiretroviral regimens following occupational exposure to HIV. However, due to the success of combination therapies in treating HIV-infected individuals, a combination of drugs should be used for PEP. Eight reports from other studies confirmed the findings that adverse events were higher with a three-drug regimen; however, discontinuation rates were not significantly different. A four-week regimen of post-exposure prophylaxis should be initiated as soon as possible after exposure, depending on the risk of seroconversion. Healthcare workers should be counseled about expected adverse events and given strategies for managing these events. They should also be advised that PEP is not 100% effective in preventing HIV seroconversion.