CDC Prevention Guidelines

Table 1:
Provisional Public Health Service recommendations for chemoprophylaxis after occupational exposure to HIV, by type of exposure and source material -- 1996

Type of                                             Antiretroviral   Antiretroviral

 exposure          Source material *                 prophylaxis +       regimen &



Percutaneous       Blood @

                    Highest risk                     Recommend       ZDV plus 3TC plus IDV

                    Increased risk                   Recommend       ZDV plus 3TC, +/- IDV **

                    No increased risk                Offer           ZDV plus 3TC

                   Fluid containing visible blood,

                    other potentially infectious

                    fluid ++, or tissue              Offer           ZDV plus 3TC

                   Other body fluid (e.g., urine)    Not offer



Mucous membrane    Blood                             Offer           ZDV plus 3TC, +/- IDV **

                   Fluid containing visible blood,

                    other potentially infectious

                    fluid ++, or tissue               Offer           ZDV, +/- 3TC

                   Other body fluid (e.g., urine)    Not offer



Skin,

 increased risk && Blood                             Offer           ZDV plus 3TC, +/- IDV **

                   Fluid containing visible blood,

                    other potentially infectious

                    fluid ++, or tissue              Offer           ZDV, +/- 3TC

                   Other body fluid (e.g., urine)    Not offer



*  Any exposure to concentrated HIV (e.g., in a research laboratory or production facility) is

   treated as percutaneous exposure to blood with highest risk.

+  Recommend -- Postexposure prophylaxis (PEP) should be recommended to the exposed worker with

   counseling (see text). Offer -- PEP should be offered to the exposed worker with counseling (see

   text). Not offer -- PEP should not be offered because these are not occupational exposures to

   HIV (1).

&  Regimens: zidovudine (ZDV), 200 mg three times a day; lamivudine (3TC), 150 mg two times a day;

   indinavir (IDV), 800 mg three times a day (if IDV is not available, saquinavir may be used,

   600 mg three times a day). Prophylaxis is given for 4 weeks. For full prescribing information,

   see package inserts.

@  Highest risk -- BOTH larger volume of blood (e.g., deep injury with large diameter hollow

   needle previously in source patient's vein or artery, especially involving an injection of

   source-patient's blood) AND blood containing a high titer of HIV (e.g., source with acute

   retroviral illness or end-stage AIDS; viral load measurement may be considered, but its use

   in relation to PEP has not been evaluated). Increased risk -- EITHER exposure to larger volume

   of blood OR blood with a high titer of HIV. No increased risk -- NEITHER exposure to larger

   volume of blood NOR blood with a high titer of HIV (e.g., solid suture needle injury from

   source patient with asymptomatic HIV infection).

** Possible toxicity of additional drug may not be warranted (see text).

++ Includes semen; vaginal secretions; cerebrospinal, synovial, pleural, peritoneal, pericardial,

   and amniotic fluids.

&& For skin, risk is increased for exposures involving a high titer of HIV; prolonged contact,

   an extensive area, or an area in which skin integrity is visibly compromised. For skin

   exposures without increased risk, the risk of drug toxicity outweighs the benefit of PEP.