HIV post-exposure prophylaxis

BIMC is a 900 bed tertiary care hospital in Manhattan that has one of the largest comprehensive AIDS treatment programs in the country. Health care workers(HCWs) who sustain a bipod and body fluid exposure are offered HIV post-exposure prophylaxis and known source patients are evaluated for HIV. BIMC implemented the revised CDC guidelines for HIV post-exposure prophylaxis with zidovudine (ZDV), 3TC and indinavir (IDV) in July 1996. Prior to this, ZDV was offered as monotherapy. To assess the impact of the revised guidelines, a retrospective review was conducted on all blood and body fluid exposures reported to the Employee Health Service (EHS) from July 1995-June 1996 and July 1996-April 1997. During July 1995-June 1996 there were 92 exposures (7.6/month). 44 source patients had known HIV serostatus or consented to HIV testing. 21 (48%) were infected with HIV. 68 (74%) HCWs were offered post-exposure prophylaxis with ZDV, 16 (24%) began prophylaxis and 2 (13%) completed prophylaxis. 2 (13%} HCWs experienced GI side effects. During July 1996-April 1997 there were 87 exposures (9.7/month). 42 source patients had known HIV serostatus or consented to HIV testing. 20 (48%) were infected with HIV. 81 (93%) HCWs were offered post-exposure prophylaxis with ZDV + 3TC + IDV, 24 (30%) began prophylaxis and 6 (25%) completed prophylaxis. 7 (29%) HCWs experienced GI side effects and/or psychological problems. There have been no seroconversions seen in either group of HCWs. Since the revised HIV post-exposure guidelines were implemented there has been an increase in reported exposures to blood and body fluids, with a significant increase (p<0.05) seen in physicians. There was a significant increase in offering prophylaxis, especially to those with HIV- or unknown source patients, and in completing therapy, despite an increase in side effects. However, there was no change in the rate of HCWs agreeing to post-exposure prophylaxis.