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Management of Post Exposure Prophylaxis for HIV

Management of Post Exposure Prophylaxis for HIV. Dr. Alap J. Mehta M.B.B.S. Fellow in HIV Medicine ( New Delhi) Fellow in Industrial Health ( Ahmadabad) Diploma in HIV Medicine (London, U.K.) cont. Abbreviations. HCP – Health Care Provider PEP – Post Exposure Prophylaxis

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Management of Post Exposure Prophylaxis for HIV

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  1. Management ofPost Exposure Prophylaxis for HIV Dr. Alap J. Mehta M.B.B.S. Fellow in HIV Medicine ( New Delhi) Fellow in Industrial Health ( Ahmadabad) Diploma in HIV Medicine (London, U.K.) cont..

  2. Abbreviations • HCP – Health Care Provider • PEP – Post Exposure Prophylaxis • OE – Occupational exposure • HIV – Human Immunodeficiency Virus • HBV – Hepatitis B Virus • HCV - Hepatitis C Virus 608, KASHI PLAZA, MAJURA GATE,SURAT

  3. Source • New York State Guideline • CDC, Atlanta Guideline for PEP 608, KASHI PLAZA, MAJURA GATE,SURAT

  4. Principle Non Discrimination Confidential 608, KASHI PLAZA, MAJURA GATE,SURAT

  5. Who are at Risk • Nursing staff and students • Laboratory technicians • Emergency care providers • Labour and delivery room personnel • General Practitioner • Physicians • Surgeons • Dentists • Health facility cleaning staff and clinical waste handlers • Interns and medical students 608, KASHI PLAZA, MAJURA GATE,SURAT

  6. Common Procedure Prone to • Recapping Needle • Blood collection • Intracath insertion • Aspiration of close cavity collection • Aspiration of abscess and lymph node • Injecting medicine • Intra operative (More Risk if Assisting) • Discarding infective material etc. • Splashes of blood/serum on face • Transferring body fluids between containers 608, KASHI PLAZA, MAJURA GATE,SURAT

  7. Magnitude of Risk • 0.3% for HIV • 3-10% for HCV • 9-30% for HBV 608, KASHI PLAZA, MAJURA GATE,SURAT

  8. Fluids need consideration 608, KASHI PLAZA, MAJURA GATE,SURAT

  9. Route wise transmission of HIV 608, KASHI PLAZA, MAJURA GATE,SURAT

  10. Common C/F to suspect HIV Symptoms • Weight Loss • Chronic Diarrhea • Newly diagnosed TB • Chronic Fever • On Chronic Therapy • Recurrent Respiratory Illness • Presenting complaints Signs • STDs • Lymphadenopathy • Herpes Zoster • Herpes Labialis • Candidacies • Wasting • Mollusum Contagious 608, KASHI PLAZA, MAJURA GATE,SURAT

  11. Approach to Occupational Exposure 608, KASHI PLAZA, MAJURA GATE,SURAT

  12. “S.T.U.M.P.E.D.” strategy • S – SOURCE PATIENT • T – TYPE OF EXPOSURE • U – UNIVERSAL WORK PRECAUTION FOLLOWED • M – MATERIAL EXPOSED • P – PERIOD SINCE LAST USE OF EQUIPMENT • E – EXPOSED BEFORE • D – DESCRIPTION OF WOUND Online evaluation will be available shortly on my website 608, KASHI PLAZA, MAJURA GATE,SURAT

  13. Most common Don’t done by HCP • Squeezing the exposed part • sucking the exposed part • Applies irritant disinfectant on exposed part 608, KASHI PLAZA, MAJURA GATE,SURAT

  14. Immediate Steps 608, KASHI PLAZA, MAJURA GATE,SURAT

  15. Steps Help a Lot • Don’t Create panic atmosphere • Separate yourself from the site and hand over the procedure to assistant if it requires continuation • Don’t blame or misbehave with patients • Call to expert after immediate step • Become a good patient and try to complete PEP if required • Get counsel your self from experts during PEP treatment 608, KASHI PLAZA, MAJURA GATE,SURAT

  16. Plan your Regime • Basic regime : Tenofovir + Emtricitabine Expanded Regime : Basic + Lopinavir / Ritonavir or Raltegravir 608, KASHI PLAZA, MAJURA GATE,SURAT

  17. Health hazards During PEP Treatment Due to medicines • Gastritis • Nausea • Vomiting • Abdominal Pain • Itching • Giddiness • Fatigue • Malaise • Anemia Due to Psych-Social issues • Re- exposure • Depression • Suicidal tendency 608, KASHI PLAZA, MAJURA GATE,SURAT

  18. Unique Situations • For sexually Active Life: Use barrier contraception FOR 6 MONTHS • For Pregnant Mother: Same protocol like other HCP • For Nursing Mothers: Stop breast feeding and top feed 608, KASHI PLAZA, MAJURA GATE,SURAT

  19. Laboratory Work Up 608, KASHI PLAZA, MAJURA GATE,SURAT

  20. Thank You CENTRE OF EXCELLENCE FOR TREATMENT OF HIV/AIDS 608, KASHI PLAZA, MAJURA GATE,SURAT

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