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Guidelines offer tips for managing occupational exposure to HIV

An intergovernmental and expert workgroup has updated guidelines to manage occupational exposure to the human immunodeficiency virus, placing emphasis on immediate treatment for health care workers regardless of risk of infection.

Previous recommendations to base the appropriate number of post-exposure drug regimens on an assessment of infection risk associated with an individual exposure have been eliminated from the U.S. Public Health Service issued guidelines.

"New guidelines reduce confusion regarding post-exposure prophylaxis, which  should greatly aid clinicians in decision-making about prophylactic treatment against accidental exposure of the virus during treatment delivery," said Dr. Edmond Truelove, vice chair of the ADA Council on Scientific Affairs.

The guidelines note that the previous recommendations, issued in 2005, were challenging to apply due to difficulty determining level of infection risk.

According to the guidelines, "To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns, and institutions should take steps to ensure that staff are aware of both the importance of and the institutional mechanisms available for reporting and seeking care for such exposures."

According to the Centers for Disease Control and Prevention:

• The risk of a dental professional contracting HIV in the clinical setting is extremely low. There are no documented cases of transmission from a patient to a dental professional.

• The risk of HIV infection following a percutaneous exposure to HIV-infected blood is about 0.3 percent and even lower for exposure through the eye, nose or mouth.

The ADA has a resource to help dental employers ensure that an employee receives timely post-exposure evaluation and follow-up. It can be downloaded here.

Published in the September issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, the guidelines call for an immediate and consistent administering of a PEP regimen following any occupational exposure. They recommend a four-week PEP regimen that consists of at least three antiretroviral drugs considered to be more tolerable than previously recommended drugs and the administering of a fourth-generation antibody/antigen test. The newer antibody/antigen test may shorten the period of follow-up HIV testing, the guidelines suggest.

The CDC, National Institutes of Health, U.S. Food and Drug Administration and the Health Resources and Services Administration developed the new guidelines in consultation with an expert panel.

The Association has updated its infection control information, including these new guidelines, available online.