Occupational Exposure to HIV: Advice for Health Care Workers
How can HIV be transmitted?
Blood, semen, vaginal secretions, vomitus, breast milk or pus from a person who is infected with HIV (human immunodeficiency virus) may contain HIV and may cause infection. The risk of acquiring HIV from a needle-stick injury is less than 1%, and the risk of infection from exposure not involving a puncture or a cut (such as a splash of body fluid onto the skin or the mucous membrane) is less than 0.1%. The risk of HIV infection from a human bite is between 0.1% and 1%.
“Clear” body fluids such as tears, saliva, sweat and urine contain little or no virus and do not transmit HIV unless they are contaminated with blood.
What should I do if I think I have been exposed?
If a skin puncture has occurred, induce bleeding at the puncture site by applying gentle pressure as you wash the area with soap and water. If skin or mucous membranes have been splashed by body fluid, immediately rinse the area thoroughly with water.
Get the name, address and phone number of the source person (patient) and the name, address and phone number of the source person’s attending physician. If you do not know the patient’s HIV status, ask the attending physician to help. If you are at work, notify your supervisor. Do not spend time now on details of how or why the exposure happened. There will be time for this later.
When do I first need to get medical care?
Seek immediate assessment and treatment from your employee health unit, your private physician or the emergency department. If anti-HIV medication is indicated, it should be taken as soon as possible. If you have a skin puncture or cut, you might need a tetanus toxoid booster, depending on the nature of the injury. Your physician will need to ask questions about the incident and other details in order to determine what treatment, if any, is necessary.
What details will I need to give my physician?
For a puncture injury–Is it a deep or surface puncture? If the puncture was caused by a needle, what gauge was the needle? Was the needle solid (suturing) or hollow? Could you see blood or bloody material on the surface of the needle or scalpel? Was the device previously in contact with patient’s body fluids? If blood was injected into you, how much? Were you wearing protective gloves?
For a skin or mucous membrane splash–Were you exposed to blood or other body fluid? How much? On what part of the body were you exposed? What size was the area of contact? What was the length of contact time? Was there a break in the skin? A rash? A bite? Were you wearing protection (e.g., gloves, eyeglasses)?
What will my physician need to know about the source person?
The HIV status of the source person–If the source person is HIV negative, he or she could be infected but may not yet have positive HIV tests (he or she may be in the “window” period). Will he or she agree to be tested or retested for HIV infection?
If the source person is HIV positive, does he or she have AIDS? Has the source person taken anti-HIV therapy? If so, what medications is he or she taking? Is he or she at the end stage of the disease (with a high quantity of virus in his or her blood and body fluids)?
If the source person will not agree to HIV testing, whether he or she is in a high-risk HIV group–Is the person an intravenous drug user or the sexual partner of an intravenous drug user, a bisexual or homosexual male, and/or a person with multiple partners? Did he or she receive a blood transfusion between 1980 and 1985? Has he or she received a blood transfusion recently?
What will I need to tell my physician about myself?
Information about any medical conditions, medications and allergies–Have you been exposed to HIV before? If so, when? How? Are you pregnant? Are you breastfeeding? Are you sexually active?
Whether you will agree to testing–Will you agree to confidential testing in order to document seroconversion (in the rare event of HIV transmission by occupational exposure)?
Should I receive post-exposure HIV prophylaxis?
Based on answers to the questions above, your physician may advise you to take medication to reduce your risk of developing HIV. Your doctor may also give medicine to protect you against hepatitis and syphilis. You will need baseline blood work, especially for evaluation of bone marrow, liver and kidney function. These tests will be repeated during the course of therapy.
Does prophylactic treatment work?
Early postexposure prophylaxis can reduce the risk of HIV infection tenfold. Even if infection occurs despite prophylaxis, early suppression of the virus can lower the “set point” for viral load and slow the course of HIV disease substantially.
Does the treatment have side effects?
Some of the medicines used can cause side effects. For example, zidovudine may cause headache, fatigue, insomnia and gastrointestinal symptoms (nausea, diarrhea, abdominal discomfort). In rare instances, lamivudine may cause pancreatitis and gastrointestinal symptoms. Indinavir and saquinavir may cause gastrointestinal upset and diarrhea. Indinavir has also been associated with kidney stones. Two quarts of fluid should be taken daily to reduce this risk.
How can I protect others from possible exposure to HIV?
Until HIV infection is ruled out, you should avoid the exchange of body fluids during sex, postpone pregnancy, and refrain from blood or organ donation. If you are breastfeeding, your baby’s doctor may ask you to switch to formula feeding.
When should I be retested for HIV?
HIV testing may be repeated at 6 weeks, 3 months and 6 months. Nearly all people found to be negative at 3 months are confirmed to be uninfected. However, the Centers for Disease Control and Prevention recommend retesting up to 6 months following the last possible exposure. If you have not formed antibodies to HIV by 6 months, then infection did not occur. Until then, you should report and seek medical evaluation if you have any acute illness. An acute illness, especially if accompanied by fever, rash or swollen lymph nodes, may be a sign of HIV infection or another medical condition.
How can I cope with my feelings?
It is natural to feel anger, self-recrimination, fear and depression after occupational exposure to HIV. During the difficult time of prevention therapy and waiting, you may want to seek support from employee-assistance programs or local mental health professionals.
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.