Friday, November 25, 2022

What To Do After Possible Hiv Exposure

Hiv Testing Outside Of A Health Care Setting Or Lab

Exposed to HIV? Get PEP (Post-Exposure Prophylaxis) | Emen8

If you are tested outside of a health care setting or lab you will likely receive a rapid HIV test

  • If the test comes back negative, and you havent had a possible exposure during the previous 3 months, you can be confident you dont have HIV.
  • If your test result is positive, you should go to a health care provider to get follow-up testing. Counselors providing the test should be able to answer questions and provide referrals for follow-up testing as well. You can use the HIV.gov locator to find a provider near you.

Types Of Hiv Tests And Their Window Periods

  • Nucleic Acid Test A NAT can usually tell you if you have HIV infection 10 to 33 days after exposure
  • Antigen/Antibody TestAn antigen/antibody test performed by a laboratory on blood from a vein can usually detect HIV infection 18 to 45 days after exposure. Antigen/antibody tests done with blood from a finger prick take longer to detect HIV .
  • Antibody TestAn antibody test can take 23 to 90 days to detect HIV infection after an exposure. Most rapid tests and self-tests are antibody tests. In general, antibody tests that use blood from a vein detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid.

Ask your health care provider or test counselor about the window period for the test youre taking and whether you will need a follow-up test to confirm the results. If youre using a self-test, you can get that information from the materials included in the tests package.

If you get an HIV test after a potential HIV exposure and the result is negative, get tested again after the window period. Remember, you can only be sure you are HIV-negative if:.

  • Your most recent test is after the window period
  • You havent had a potential HIV exposure during the window period. If you do have an exposure, then you will need to be retested.

Hiv And Occupational Exposure

Occupational HIV transmission is extremely rare.

Only 58 cases of confirmed occupational HIV transmission to health care personnel have been reported in the United States. An additional 150 possible transmissions have also been reported to CDC.*

How can I prevent occupational HIV transmission?

Follow Standard Precautions at all times. Assume that blood and other body fluids are potentially infectious.

What if an HIV exposure happens at work?

If you are exposed to HIV at work, report your exposure to the appropriate person, and see a doctor or visit an emergency room right away.

Post-exposure prophylaxis can reduce your chance of getting HIV infection. It must be started within 72 hours after you may have been exposed to HIV. But the sooner you start PEP, the better. Every hour counts!

Clinicians caring for personnel whove had a possible exposure can call the PEPline for advice on managing the exposure. Clinicians who administer PEP should tell patients about possible side effects and follow patients closely to make sure they take their medicine correctly.

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Risk Of Infection Following An Exposure To Hiv

Factors that increase the risk of transmission: Many factors that contribute to HIV infection are shared by the 4 PEP scenarios outlined below. HIV transmission risk depends on the viral load of the source with HIV and the type of exposure . Factors that increase the risk of HIV transmission include early- and late-stage untreated HIV infection and a high level of HIV RNA in the blood , the presence of genital or anorectal ulcers from sexually transmitted infections , and direct blood-to-blood exchange, such as syringe sharing during injection drug use .

Factors that decrease the risk of HIV transmission: Similarly, across the 4 PEP scenarios, there are shared factors that decrease the risk of HIV infection. HIV transmission risk is low and often negligible when the source of the exposure has a low or undetectable viral load and is lower if the source is circumcised or is taking antiretroviral medications as pre-exposure prophylaxis . In the context of sexual exposure, there is a robust body of evidence that individuals do not sexually transmit HIV if they are taking antiretroviral therapy and have an undetectable viral load see NYSDOH AI U=U Guidance for Implementation in Clinical Settings. Data are insufficient to make recommendations regarding HIV transmission via breastfeeding.

What Does Pep Consist Of

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PEP is a combination of HIV drugs that can stop the virus from permanently entering the body. It can be used after the event if youve put yourself a risk of HIV transmission.

To work, PEP must be taken within 72 hours , and ideally should be taken within 24 hours.

PEP is not a morning after pill for HIV, and its not guaranteed to work. Its meant as an emergency measure to be used as a last resort, such as if a condom fails during sex. Taking PEP will not protect you from other sexually transmitted infections or unwanted pregnancy.

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A Word About Window Periods

The window period refers to the time it takes for HIV to show up in an HIV test. The length of the window period will depend on the type of test you take.

If you feel like you may be at risk of HIV, do not wait, speak to a healthcare professional as soon as possible. The most important thing is to test.

If you test negative but think you may have been exposed to HIV more recently, you can take another test once the window period has passed.

The picture below shows the window periods for different HIV tests. Some tests can give you an accurate result within four weeks, while others can take three months to be accurate .

A healthcare worker will be able to explain how long the window period is for the test you are taking, and will tell you if they think youll need to test for HIV again.

Hiv Testing In A Health Care Setting Or Lab

If you take a test in a health care setting or a lab, a health care provider or lab technician will take your sample . If its a rapid test, you may be able to wait for the results, but if its a laboratory test, it can take several days for your results to be available. Your health care provider or counselor may talk with you about your risk factors, answer any questions you might have, and discuss next steps with you, especially if your result is positive.

  • If the test comes back negative, and you havent had an exposure during the window period for the test you took, you can be confident you dont have HIV.
  • If your HIV test result is positive, the lab will conduct follow-up testing, usually on the same sample as the first.

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Pep For The Pregnant Or Breastfeeding Medical Worker

As with all medications, the risks and benefits of PEP should be discussed with the pregnant medical worker who has sustained an exposure. All pregnant people starting antiretroviral therapy should be entered into the Antiretroviral Pregnancy Registry, a database designed to collect information on the outcomes of antiretroviral-exposed pregnancies regardless of HIV status. Most antiretroviral drugs are category B or C. Based on limited data, the benefit of antiretroviral drugs in pregnancy, including during the first trimester, outweigh the risks and do not appear to increase the risk of birth defects.

Drugs to avoid during pregnancy are well covered in Antiretroviral Therapy for Pregnant HIV-Infected Patients. Contraindicated medications per the FDA include efavirenz , indinavir, and the combination of didanosine and stavudine. According to CDC and FDA guidance, dolutegravir should also be avoided in the first trimester because of concerns regarding an increased risk for neural tube defects. However, it is important to point out that the Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission does not place restrictions on either dolutegravir or efavirenz during pregnancy. Based on increasing clinical experience with ART, PEP is indicated at any time during pregnancy when a significant exposure has occurred.

How Well Does Pep Work

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PEP is effective in preventing HIV infection when its taken correctly, but its not 100% effective. The sooner you start PEP after a possible HIV exposure, the better.

While taking PEP, its important to use other HIV prevention methods, such as using condoms the right way, every time you have sex and using only new, sterile needles and works when injecting drugs

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Where To Get Pep

PEP is available on the NHS for free, but is only given to people who meet guidelines about its use.

The best place to get PEP is a sexual health or HIV clinic. If you need PEP over the weekend or outside of office hours, when clinics will often be closed, the best place to go is an Accident and Emergency department.

PEP is not normally available from GPs.

As PEP is a powerful course of drugs, and is expensive to prescribe, you might be asked about:

  • the person you had sex with
  • what sort of sex you had
  • if the other person had HIV, what their viral load is.

If the person you had sex with is living with HIV and has an undetectable viral load, you will not need PEP as it wont be possible for the virus to have been transmitted.

Once a doctor decides that its appropriate for you to have PEP, you will be asked to take an HIV test. This is to make sure you dont already have HIV. If HIV is detected by a test, other forms of treatment will be recommended to you.

What Is An Hiv Test

An HIV test shows whether you are infected with HIV . HIV is a virus that attacks and destroys cells in the immune system. These cells protect your body against disease-causing germs, such as bacteria and viruses. If you lose too many immune cells, your body will have trouble fighting off infections and other diseases.

There are three main types of HIV tests:

  • Antibody Test. This test looks for HIV antibodies in your blood or saliva. Your immune system makes antibodies when you are exposed to bacteria or viruses, like HIV. An HIV antibody test can determine if you have HIV from 312 weeks after infection. Thatâs because it can take a few weeks or longer for your immune system to make antibodies to HIV. You may be able to do an HIV antibody test in the privacy of your home. Ask your health care provider about at-home HIV test kits.
  • HIV Antibody/Antigen Test. This test looks for HIV antibodies and antigens in the blood. An antigen is a part of a virus that triggers an immune response. If youâve been exposed to HIV, antigens will show up in your blood before HIV antibodies are made. This test can usually find HIV within 26 weeks of infection. The HIV antibody/antigen test is one of the most common types of HIV tests.
  • HIV Viral Load. This test measures the amount of the HIV virus in the blood. It can find HIV faster than antibody and antibody/antigen tests, but it is very expensive. It is mostly used for monitoring HIV infections.

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Occupational Exposure Risk Evaluation

PEP is indicated whenever an occupational exposure to blood, visibly bloody fluids, or other potentially infectious material occurs through percutaneous or mucocutaneous routes or through non-intact skin. , below, illustrates the steps in determining whether ongoing PEP is indicated after the first emergency dose. Occupational exposures for which PEP is indicated include the following:

Occupational exposures for which PEP is indicated include the following:

  • Break in the skin by a sharp object that has been in the sources blood vessel or is contaminated with blood, visibly bloody fluid, or other potentially infectious material.
  • Bite from a patient with visible bleeding in the mouth that causes bleeding in the exposed individual.
  • PEP is not indicated for an exposure to saliva, including from being spat on, in the absence of visible blood.
  • Splash of blood, visibly bloody fluid, or other potentially infectious material to the mouth, nose, or eyes.
  • A non-intact skin exposure to blood, visibly bloody fluid, or other potentially infectious material.
  • Occupational HIV Exposure: Post-Exposure Prophylaxis and Exposure Management When Reported Within 72 Hours. See also: Management of Potential Exposure to Hepatitis B VirusandManagement of Potential Exposure to Hepatitis C Virus in the full guideline.

    Path To Improved Health

    Human Immunodeficiency Virus (HIV)  Sexpression:UK

    There are many ways to prevent occupational exposure to HIV. To start, health care workers should treat all body fluids the same way. You should assume they are infected and take precautions, including:

    • Use protective covering, such as gloves and goggles. You always should do this when dealing with blood and body fluids.
    • Wash your hands and other skin areas right after contact with blood and body fluids.
    • Be careful when handling and disposing of needles and sharp instruments.
    • Use available safety devices to prevent needlestick injuries.
    • Be aware of your employers postexposure processes.

    Be aware of your organizations policies and procedures to follow when an exposure occurs. If it does occur, follow the basic steps below:

    • For a skin puncture, induce bleeding at the wound site. Do this by applying gentle pressure as you wash the area with soap and water.
    • For a skin or mucous splash, rinse the area with water.
    • Get the infected persons information. This includes name, address, phone number, and HIV status. If a patient, get their doctors contact information.
    • Notify your supervisor and coworkers. If your place of work has other procedures in place, follow those .
    • Seek immediate medical care. Go to your employee health unit, emergency department, or personal doctor.

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    Who Should Consider Taking Prep

    PrEP is for people without HIV who are at very high risk for getting it. This includes:

    Gay/bisexual men who

    • Have an HIV-positive partner
    • Have multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown and
    • Have anal sex without a condom OR
    • Have been diagnosed with a sexually transmitted disease in the last 6 months

    Heterosexual men and women who

    • Have an HIV-positive partner
    • Have multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown and
    • Don’t always use a condom when having sex with people who inject drugs OR
    • Don’t always use a condom when having sex with bisexual men

    People who inject drugs and

    • Share needles or other equipment to inject drugs OR
    • Are at risk for getting HIV from sex

    If you have a partner who is HIV-positive and are considering getting pregnant, talk to your health care provider about PrEP. Taking it may help protect you and your baby from getting HIV infection while you try to get pregnant, during pregnancy, or while breastfeeding.

    How Soon Can I Take An Hiv Test

    This question usually refers to how soon after exposure can someone test for HIV.

    This used to involve waiting 3 to 4 weeks before taking an HIV test .

    However, 2020 UK guidelines now recommend waiting 6 weeks.

    This is because 4th generation HIV tests will detect 99% of infections at 6 weeks compared to 95% of infections 4 weeks after exposure.

    A negative test after four weeks needs to be confirmed with a second test three months after the risk. This is to cover the small chance that you take longer than four weeks to generate an antibody response.

    Extending this to 6 weeks means the confirmatory test is no longer needed.

    In high risk exposures, especially if symptoms occur, viral load testing is sometimes used after one week. This includes after a sexual assault or after a needlestick injury to a healthcare worker.

    In these cases a viral load test can exclude an infection when there are symptoms.

    Viral load tests are not approved to diagnose HIV. A negative result still needs to be confirmed by an antibody test three months after the risk.

    Figure 6: Recommended time from exposure to HIV test *

    * This diagram needs to be updated to show the six-week window.

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    Who Pays For Pep

    Antiretroviral medications are expensive, and many people cannot pay for them out of pocket. If you are a healthcare worker who was exposed to HIV on the job, your workplace health insurance or workers’ compensation will usually pay for oPEP. If you are prescribed nPEP after sexual assault, you may qualify for partial or total reimbursement for medications and clinical care costs through the Office for Victims of Crime funded by the U.S. Department of Justice . If you are prescribed nPEP for another reason, and you cannot get insurance coverage , your healthcare provider can help you apply for free antiretroviral medications through the patient assistance programs of the drug manufacturers. Online applications can be faxed to the company, or some companies have special phone lines. These can be handled urgently in many cases to avoid delay in accessing medication. See information for specific medications and manufacturers.

    As with many other conditions, early detection offers more options for treatment.

    Are There Any Other Hiv Prevention Options

    HIV Prevention Lets Talk About PEP

    There are many easy and effective ways to prevent HIV. Other than PEP, HIV transmission can also be prevented by:

    • Using condoms with water or silicone-based lubricant during anal or vaginal sex.
    • Using clean, sterile injecting equipment.
    • Taking pre-exposure prophylaxis for people who are at risk of HIV transmission.
    • achieving and maintaining undetectable HIV viral loads if you are HIV-positive by taking HIV antiretroviral treatment as prescribed.

    Depending on your risk factors and life circumstances, you may be more suited to other HIV prevention methods. It is important to find the right prevention method, or combination of methods, that works for you and your sexual partners.If you have used PEP more than once, you may wish to talk to your GP about starting pre-exposure prophylaxis or PrEP for HIV prevention. PrEP is a pill taken once a day and is 99% effective at preventing HIV transmission if taken consistently as prescribed.

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