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Potentially infectious body fluids are blood, semen, vaginal secretions, rectal secretions, breast milk or other body fluid that is contaminated with visible blood.
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Short-course oral zidovudine for prevention of mother-child transmission of HIV-1 in Abidjan, Cote d'Ivoire: a randomized trial. Med Health RI ; In Vancouver, 71 of assault survivors accepted the 5-day starter pack of nPEP, 29 returned for additional doses, and eight completed 4 weeks of therapy If a illinoiss diagnosis of HIV infection is made or evidence of other sexually transmitted infection is identified, the patient should be assisted in notifying their sexual and drug-use contacts. Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS.
The same rationale indicates that nevirapine should not be used for nPEP.
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Antiretroviral Side Effects and Toxicity Initial concerns about severe side effects and toxicities have been ameliorated by experience with health-care workers who have taken PEP after occupational exposures. Persons who engage in behaviors that result in frequent, recurrent exposures that would require sequential or near-continuous courses of antiretroviral medications e.
Management of accidental exposure to HIV. When aeeking is prescribed to women of childbearing potential, they should be instructed about the need to avoid pregnancy.
In judging whether exposures are isolated, episodic, or ongoing, clinicians should consider that persons who continue to engage in risk behaviors e. These additional factors might assist in the decision whether to agge or complete a course of nPEP.
Because of potential teratogenicity, efavirenz should not be used in any nPEP regimen during pregnancy or among women of childbearing age at risk for becoming pregnant during the course of antiretroviral prophylaxis Table 3. Evidence from animal studies and human observational studies demonstrate that nPEP administered within hours and continued for 28 days might reduce the risk for acquiring HIV infection after hj and other nonoccupational exposures.
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Survey of nonoccupational HIV postexposure prophylaxis in hospital emergency departments. Jackson, Jr. In macaques, PMPA tenofovir blocked simian immunodeficiency virus SIV infection after intravenous challenge if administered within 24 hours illlinois exposure and continued for 28 days. Postexposure prophylaxis for human immunodeficiency virus HIV infection following sexual assault.
The U. Although these studies demonstrate that nPEP might reduce the risk for infection after sexual HIV exposures, participants were not randomly ased, and sample sizes were too small for statistically ificant conclusions.
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The guide to living with HIV infection fifth edition. The sooner nPEP is administered after exposure, the more likely it is to interrupt transmission. Fong C. Effectiveness of postinoculation R 2-phosphonylmethoxypropyl adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment.
Treatment of primary human immunodeficiency virus type 1 infection with potent antiretroviral therapy reduces frequency of rapid progression to AIDS. When a source-person is not known to be infected with HIV, the risk for exposure and therefore the potential benefit of nPEP is unknown. J Exp Med ; Bell DM.
In addition, any sexual exposure that presents a risk for HIV infection might also place a patient at risk for acquiring other sexually transmitted infections, including hepatitis B. Evaluation for Sexually Transmitted Infections, Hepatitis, and Emergency Contraception Evaluation for sexually transmitted infections is important because these infections might increase the risk for acquiring HIV infection from a sexual exposure.
Among the patients tested, several were infected with strains that were resistant to antiretroviral medications. Selden L.
Specifically, the terms safe and effective might not be synonymous with the FDA-defined legal standards for product approval. Adherence has been reported to be especially poor among sexual assault survivors Langford iillinois. In a study in Brazil 24virus obtained on day 28 of therapy from the only treated person who seroconverted whose regimen included 3TC had a 3TC-resistance mutation.
Illiois patients have frequently recurring exposures and would not benefit from nPEP because 4 weeks of potential protection cannot substantially reduce their overall risk for acquiring HIV infection. If the source-person is willing, the clinician might consider drawing blood illjnois viral load and resistance testing, the of which might be useful in modifying the initial nPEP medications if the can be obtained promptly Crystal N.
Sexual transmission during the incubation period of primary HIV infection.
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Reporting and Confidentiality Because of the emotional, social, and potential financial consequences of possible HIV infection, clinicians should handle nPEP evaluations with the highest level of confidentiality. Sexual exposure to HIV infection: is grl a role for emergency prophylaxis? One of the HAART combinations recommended for the treatment of persons with established HIV infection should be selected on the basis of adherence, toxicity, and cost considerations Tables 2 and 3 87,