Immediate HIV Post-Exposure Prophylaxis for Occupational Blood Exposure

Introduction to PEP

The Centers for Disease Control and Prevention (CDC) recommends starting HIV post-exposure prophylaxis (PEP) immediately, ideally within the first hour and absolutely within 72 hours of the exposure, using a 28-day course of combination antiretroviral therapy 1.

The American College of Occupational and Environmental Medicine recommends washing the exposure site thoroughly with soap and water right away, and if blood splashed into eyes, nose, or mouth, flushing immediately with clean water or saline 2, 1.
Seek emergency medical evaluation within 1 hour to initiate PEP, as the sooner PEP is started, the more effective it is—effectiveness drops dramatically after 72 hours 1.
The actual risk of HIV transmission from a needlestick with HIV-infected blood is approximately 0.3% (3 per 1,000 exposures), but PEP reduces this risk by approximately 81% when started promptly 1.

The CDC recommends the preferred regimen of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF)—a single tablet taken once daily for 28 days 1, 3.
An alternative preferred regimen is Dolutegravir 50mg daily plus emtricitabine/tenofovir alafenamide (Descovy) daily 3.
Do not delay PEP initiation while awaiting additional testing or expert consultation—start immediately with the preferred regimen 3.

Baseline testing before starting PEP should include HIV antigen/antibody combination test, hepatitis B serology, hepatitis C antibody, renal function, complete blood count, and hepatic function tests 1, 3.
Follow-up HIV testing schedule: 4-6 weeks post-exposure, 3 months post-exposure, and 6 months post-exposure 2, 1, 3.

Monitor for drug toxicity every 2 weeks during the 28-day PEP course, including complete blood count, renal function tests, and hepatic function tests 2, 1, 3.
Reevaluate within 72 hours of starting PEP 1, 3.

For the next 6 months, use barrier protection (condoms) during sexual activity, do not donate blood, plasma, organs, tissue, or semen, and seek immediate medical evaluation for any acute illness 6, 7, 1, 3.

Do not wait for source patient confirmation before starting PEP, and do not delay beyond 72 hours 3, 4, 5.
Pregnancy does not preclude PEP use, and if applicable, this should be discussed but should not delay initiation 8.

Access to counseling is essential, as the emotional impact of occupational HIV exposure is often substantial, and healthcare facilities should provide counseling for the emotional effects and medication adherence support 2, 9.