What is the treatment for non-HIV-infected people who are exposed to the genital secretions or blood of someone with HIV?
Blood and genital secretions from people with HIV are considered infectious and the utmost care should be taken in handling them. Fluids that are contaminated with blood also are potentially infectious. Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomit are not considered infectious unless visibly bloody.
The most commonly reported occupational exposures are
- an inadvertent needle stick (usually when drawing blood from someone with AIDS);
- a cut from a sharp object such as a scalpel that is contaminated with blood;
- exposure of mucous membranes to infectious fluid (mucous membranes that may be exposed to splashes of material include the mouth, nasal passages, and eyes);
- exposure of open sores or abraded/inflamed skin to infectious material.
The average risk of HIV infection after a needle-stick injury is around 0.3% and after mucous-membrane exposure to blood is approximately 0.09%. For abraded skin exposure, the risk is estimated to be less than mucous membrane exposure. There also are some factors that may affect the risk for HIV transmission such as the amount of blood from the infected source. Deep injury from a needle, visible blood in/on the needle, or a needle that was being placed in an artery or vein are examples of higher-risk situations. The risk of transmission also depends on the number of virus particles in the blood, with higher viral loads leading to an increased risk of transmission.
If an exposure occurs, the exposed person can reduce the risk of getting HIV by taking antiretroviral medications. Current recommendations suggest two or more antiretroviral medications, depending on the risk of transmission and type of exposure. Medications should be started as soon as possible, preferably within hours of exposure and should be continued for four weeks, if tolerated. People who have been exposed should be tested for HIV at the time of the injury and again at six weeks, 12 weeks, and six months after exposure.
It is important to document that an exposure has occurred or was likely. A needle stick from a person with HIV or a person likely to have HIV constitutes a significant exposure. Medications should be started immediately. If it is unknown whether the person who is the source of the potentially infected material has HIV, the source person can be tested. Medications that were started immediately in the exposed person can be discontinued if the source person does not turn out to carry HIV. Potentially infectious material splashed in the eye or mouth, or coming into contact with non-intact skin, also constitutes an exposure and should prompt immediate evaluation to determine if medications should be started.
Other potential exposures include vaginal and anal sexual intercourse and sharing needles during intravenous drug use. There is less evidence for the role of antiretroviral postexposure prophylaxis after these exposures. In part, this is because the HIV status of a sexual partner or drug user is not usually known by the exposed person. Nevertheless, the U.S. Centers for Disease Control and Prevention (CDC) recommends treatment for people exposed through sexual activity or injectable drug use to someone who is known to carry HIV. If the HIV status of the source is not known, the decision to treat is individualized. Concerned people should see their physician for advice. If a decision to treat is made, medications should be started within 72 hours of the exposure.
For every exposure, especially with blood, it is important to test for other blood-borne diseases like hepatitis B or C, which are more common among HIV-infected patients. Reporting to a supervisor, in the case of health care workers, or seeking immediate medical consultation is advisable. For sexual exposures, testing for syphilis, gonorrhea, chlamydia, and other sexually transmitted diseases (STDs) usually should be done because individuals with HIV are more likely to have other STDs. Patients also should be counseled about how to prevent exposure in the future.