geoscience.net logo
+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

HIV exposure through contact with body fluids


, : HIV exposure through contact with body fluids. Prescrire International 21(126): 100-1, 103-5

A variety of situations, either accidental or linked to high-risk behaviour, raise concerns about potential infection from contact with the blood or genital secretions of a person who may be HIV-infected. Antiretroviral post-exposure prophylaxis is offered to prevent establishment of HIV infection. As of 2011, what is the evidence for the efficacy of antiretroviral post-exposure prophylaxis? Under what circumstances is this treatment justified? To answer these questions, we reviewed the available evidence, based on the standard Prescrire methodology. The evidence for the efficacy of rapidly initiated prophylaxis following exposure comes mainly from one case-control study on health professionals injured while treating HIV-positive patients. Treatment with zidovudine for 3 to 4 weeks was associated with a risk of HIV seroconversion that was 5 times lower than among those not treated. The main clinical practice guidelines recommend the use of antiretroviral treatments that are already well established for chronic HIV infection as post-exposure prophylaxis. A typical regimen combines HIV-protease inhibitors (ideally lopinavir + ritonavir) with a fixed-dose combination of two nucleoside (or nucleotide) reverse transcriptase inhibitors (emtricitabine + tenofovir or lamivudine + zidovudine). Certain antiretrovirals are best avoided as first-choice therapy due to their adverse effects: abacavir due to the risk of serious allergic reactions; atazanavir due to the risk of jaundice and torsades de pointes. Non-nucleoside reverse transcriptase inhibitors (such as efavirenz) frequently cause adverse cutaneous and neurosensory adverse effects, especially during the first weeks of treatment. The main adverse effects of antiretrovirals are gastrointestinal. Diarrhoea is common with lopinavir. Antiretrovirals interact with many other drugs. HIV-protease inhibitors reduce the efficacy of hormonal contraceptives. The Iopinavir + ritonavir + zidovudine + lamivudine combination has been used for a long time to treat pregnant women. No evidence of teratogenicity has been shown.The antiretrovirals atazanavir, emtricitabine, nelfinavir, nevirapine and tenofovir can also be used but there is less experience with their use during pregnancy. Post-exposure treatment should be started as soon as possible: wash and rinse the wound; initiate antiretroviral therapy within 48 to 72 hours, without waiting to obtain all the information required for risk assessment; reassess the infection risk 2 to 4 days later. Risk assessment should be based on the type and circumstances of exposure, and the source person's serological HIV status and viral load if the individual is known to be HIV-infected and receiving treatment.This information should be obtained urgently or estimated on the basis of HIV infection is still possible despite post-exposure prophylaxis.Therefore, in order to avoid transmitting the virus to others, anyone exposed and potentially infected should be advised against unprotected sex or blood donation for 3 months, until serological evidence has been obtained that they have not been infected. In practice, the many situations in which the risk of infection is uncertain should be managed on a case-by-case basis, with the patient's involvement, weighing the probability of HIV transmission against the adverse effects of a one-month course of antiretroviral therapy.

US$29.90

PMID: 22515138


Other references

Wolf, D.; Cammas, F.; Losson, Régine.; Goff, S.P., 2008: Primer binding site-dependent restriction of murine leukemia virus requires HP1 binding by TRIM28. TRIM28 is a transcriptional corepressor which is required for primer binding site (PBS)-dependent restriction of murine leukemia virus (MLV) replication in embryonic stem and embryonic carcinoma (EC) cells. PBS-dependent restriction of MLV leads...

van den Berg, M., 2006: Tourism and nature in Ecuador Toerisme en natuur in Ecuador. Amoeba. februari; 801: 22-24

Bengtson, DA.; Beck, AD.; Poston, HA., 1978: Comparative effects of live and artificial diets on growth and survival of juvenile Atlantic silverside, Menidia menidia. Proceedings of the Annual Meeting of the World Mariculture Society, 9: 159-173

Jennie L.B.ierley; Jennifer A.S.ewart; Alison K.L.es, 2009: Quantifying potato pathogen DNA in soil. An improved method for the direct extraction of DNA from soil involving processing of a relatively large sample (60 g) was developed. The accurate and reliable detection and quantification of the soil-borne potato pathogens Colletotrichum coc...

Laisne G., 1978: Influence of the culture medium composition on the morphology of mentha viridis cultivated in vitro. Comptes Rendus Hebdomadaires Des Seances De L'Academie Des Sciences Serie D Sciences Naturelles: 29-32

Lung, B.; Garbarz, E.; Michaud, P.; Helou, S.; Farah, B.; Berdah, P.; Prendergast, B.; Doutrelant, L.; Luxereau, P.; Cormier, B.; Michel, P.L.uis; Vahanian, A., 1998: What are the long-term results of percutaneous mitral commissurotomy in patients with no or few symptoms?. Circulation 98(17 SUPPL ): I352, Oct 27

Yuksel, A.; Olmez, T., 2016: A neural network-based optimal spatial filter design method for motor imagery classification. In this study, a novel spatial filter design method is introduced. Spatial filtering is an important processing step for feature extraction in motor imagery-based brain-computer interfaces. This paper introduces a new motor imagery signal classifi...

Milano, C., 2012: Human factors inhibit medication adherence. Managed Care 20(12): 53-56

Dobrovol'skaia, G.I.; Surkina, E.K., 1978: Experience with controlled ambulatory chemotherapy of tuberculosis. Problemy Tuberkuleza: 25-27

Goinard, P.; Pelissier, G., 1966: Report on 8 years of experience with sphincterotomies. Revue Internationale D'hepatologie 16(3): 605-609