Postexposure Chemoprophylaxis for Occupational Exposures to the Human Immunodeficiency Virus

Henderson, David K.

doi:10.1001/jama.281.10.931

Cited by 48 publications

(21 citation statements)

References 48 publications

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“…The risk of HIV however is low and is substantially lower than the risk of transmission of HBV and HCV (50). In the event of HIV exposure, current regimens provide effective prophylaxis (51). As HIV infection is associated with a pro-thrombotic state, concerns have been raised regarding an increased risk of vascular complications post transplantation (52).…”

Section: Post Liver Transplantationmentioning

confidence: 99%

The Role of Liver Transplantation in HIV Positive Patients

Joshi¹,

Agarwal²

2012

Immunodeficiency

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Section: Post Liver Transplantationmentioning

confidence: 99%

The Role of Liver Transplantation in HIV Positive Patients

Joshi¹,

Agarwal²

2012

Immunodeficiency

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“…52 In the event of HIV exposure, current regimens provide effective prophylaxis. 53 Standard surgical techniques for vascular and biliary anastomoses apply. Because of the increased prothrombotic risk that HIV infection confers, we recommend the introduction of prophylactic subcutaneous heparin (5000 U every 8 hours) once the international normalized ratio is less than 1.5 and the platelet count is greater than 50 Â 10 9 cells/L.…”

Section: Transplantation and Immunosuppressionmentioning

confidence: 99%

Liver transplantation in human immunodeficiency virus-positive patients

et al. 2011

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“…The data have been reviewed extensively elsewhere. 6,19,20,[27][28][29] A brief summary is presented here.…”

Section: Scientific Historical and Adult Experience With Hiv Pepmentioning

confidence: 99%

“…Lot et al 50 of France reported that as of 55 The animal data supporting the use of PEP in HIV exposures, reviewed extensively elsewhere, primarily consist of exposures of primates to simian immunodeficiency virus (SIV) and the employment of various antiretroviral compounds against the virus. 6,19,20,[27][28][29] Successful prophylaxis did occur in several trials, especially when given early and for a prolonged period. Timing of delivery and duration of therapy were also deemed of special importance to the efficacy of HIV PEP.…”

Section: Scientific Historical and Adult Experience With Hiv Pepmentioning

confidence: 99%

“…19,20,[27][28][29]59 Antiretroviral medications given during this period may help to diminish or end viral replication, thereby reducing the viral inoculum to a more potentially manageable target for the host's defenses. Failures of HIV PEP probably occur because 1) the initial viral load was too great, 2) the rate of viral replication exceeded the body's attempts to destroy the virus or the medications' ability to halt viral replication, 3) the viral strain was resistant to the medication, and/or 4) the host's immune system was somehow impaired.…”

Section: Scientific Historical and Adult Experience With Hiv Pepmentioning

confidence: 99%

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Human Immunodeficiency Virus Postexposure Prophylaxis for Adolescents and Children

Merchant

Keshavarz

2001

Pediatrics

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ABSTRACT. Children and adolescents are at risk for human immunodeficiency virus (HIV) infection. Transmission occurs through perinatal exposures, injecting drug use, consensual and nonconsensual sex, needlestick and sharp injuries, and possibly some unusual contacts. Youth engaging in high-risk sexual activities are especially endangered. Half of the estimated worldwide 5.3 million new HIV infections occur in adolescents and young adults aged 15 to 24. Of 20 000 known new adult and adolescent cases in the United States, 25% involve 13-to 21-year-olds. More than 1.4 million children worldwide (aged 15 and younger) are believed to be infected, and >1640 new cases are diagnosed daily. Of the 432 000 people reported to be living with HIV or acquired immunodeficiency syndrome (AIDS) in the United States, 5575 are children under 13.HIV postexposure prophylaxis (PEP) is a form of secondary HIV prevention that may reduce the incidence of HIV infections. HIV PEP is commonly conceived of as 2 types: occupational and nonoccupational. Occupational HIV PEP is an accepted form of therapy for health care workers exposed to HIV through their jobs. A landmark study of healthcare workers concluded that occupational HIV PEP may be efficacious. Well-established US national guidelines for occupational HIV PEP exist for this at-risk population.Nonoccupational HIV PEP includes all other forms of HIV PEP, such as that given after sexual assault and consensual sex, injecting drug use, and needle-stick and sharp injuries in non-health care persons. Pediatric HIV PEP is typically the nonoccupational type. The efficacy of nonoccupational HIV PEP is unknown. The presumed efficacy is based on a collection of animal and human data concerning occupational, perinatal, and nonoccupational exposures to HIV. In contrast to occupational HIV PEP, there are no national US guidelines for nonoccupational HIV PEP, and few recommendations are available for its use for adolescents and children. Regardless of this absence, there is encouraging evidence supporting the value of HIV PEP in its various forms in pediatrics.Although unproven, the presumed mechanism for HIV PEP comes from animal and human work suggesting that shortly after an exposure to HIV, a window period exists during which the viral load is small enough to be controlled by the body's immune system. Antiretroviral medications given during this period may help to diminish or end viral replication, thereby reducing the viral inoculum to a more potentially manageable target for the host's defenses.HIV PEP is accepted practice in the perinatal setting and for health care workers with occupational injuries. The medical literature supports prescribing HIV PEP after community needle-stick and sharp injuries and after sexual assault from sources known or likely to be HIV-infected. HIV PEP after consensual unprotected intercourse between HIV sero-opposite partners has had growing use in the adult population, and can probably be utilized for children and adolescents. There is less documented experience...

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Postexposure Chemoprophylaxis for Occupational Exposures to the Human Immunodeficiency Virus

Cited by 48 publications

References 48 publications

The Role of Liver Transplantation in HIV Positive Patients

The Role of Liver Transplantation in HIV Positive Patients

Liver transplantation in human immunodeficiency virus-positive patients

Human Immunodeficiency Virus Postexposure Prophylaxis for Adolescents and Children

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