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Overview
Source: National Center for Infectious Diseases
Centers for Disease Control and Prevention
An occupational exposure that may place a worker at risk of HIV infection is defined as a percutaneous injury (e.g., a needlestick or cut with a sharp object) or contact of mucous membranes or skin with blood, tissues, or other body fluids to which universal precautions apply, including laboratory specimens that contain HIV (especially when the exposed skin is chapped, abraded, or afflicted with dermatitis or the contact is prolonged or involves an extensive area). After an occupational exposure, the source patient should be informed of the incident and tested for serologic evidence of HIV infection and hepatitis B surface antigen after consent is obtained. Policies should be developed for testing source patients in situations in which consent cannot be obtained (such as in the case of an unconscious patient).
If the source patient has AIDS, is known to be HIV-seropositive, or refuses testing, the worker should be evaluated clinically and serologically for evidence of HIV infection as soon as possible after the exposure (baseline) and, if seronegative, should be retested periodically for a minimum of 6 months after exposure (for example, 6 weeks, 12 weeks, and 6 months after exposure) to determine whether HIV infection has occurred. The worker should be advised to report and seek medical evaluation for any acute illness that occurs during the follow-up period. Such illness, particularly if characterized by fever, rash, or lymphadenopathy, may be indicative of acute HIV infection, drug reaction, or another medical condition. During the follow-up period, especially the first 6-12 weeks after the exposure when most infected persons are expected to seroconvert, exposed workers should follow PHS recommendations for preventing transmission of HIV. These recommendations include refraining from blood, semen, or organ donation and abstaining from or using measures to prevent HIV transmission during sexual intercourse. In addition, in countries such as the United States where safe and effective alternatives to breastfeeding are available, exposed women should not breastfeed infants during the follow-up period in order to prevent the infants' possible exposure to HIV in breast milk. During all phases of follow-up, confidentiality of the worker and the source patient should be protected.
If the source individual is HIV-seronegative and has no clinical manifestations of AIDS or HIV infection, no further HIV follow-up of the exposed worker is necessary unless epidemiologic evidence suggests that the source individual may have recently been exposed to HIV or testing is desired by the worker or recommended by the health care provider. In these instances, the recommendations described above should be followed.
If the source person cannot be identified, decisions regarding appropriate follow-up should be individualized, based on factors such as whether potential sources are likely to include a person at increased risk of HIV infection.
The employer should make serologic testing available to all workers who are concerned about possible infection with HIV through an occupational exposure. Appropriate psychological counseling may be indicated as well.
Source: The Centers for Disease Control and Prevention
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