DiversityNursing Blog

DONALD G. McNEIL Jr.

A major study testing whether Americans would take their H.I.V. drugs every day if they were paid to do so has essentially failed, the scientists running it announced Tuesday at an AIDS conference here.

Paying patients in the Bronx and in Washington — where infection rates are high among poor blacks and Hispanics — up to $280 a year to take their pills daily improved overall adherence rates very little, the study’s authors said.

The hope was that the drugs would not only improve the health of the people taking them, but help slow the spread of H.I.V. infections. H.I.V. patients who take their medicine regularly are about 95 percent less likely to infect others than patients who do not. The Centers for Disease Control and Prevention estimates that only a quarter of all 1.1 million Americans with H.I.V. are taking their drugs regularly enough to not be infectious.

Paying patients $25 to take H.I.V. tests, and then $100 to return for the results and meet a doctor, also failed, the study found.

“We did not see a significant effect of financial incentives,” said Dr. Wafaa M. El-Sadr, an AIDS expert at Columbia University and the lead investigator. But, she said, there is “promise for using such incentives in a targeted manner.”

Cash payments might still work for some patients and some poor-performing clinics, she said.

Other H.I.V.-prevention research released here Tuesday offered good news for gay men but disappointing results for African women.

Two studies — both of gay men, one in Britain and the other in France — confirmed earlier research showing that pills to prevent infection can be extremely effective if taken daily or before and after sex. Both were stopped early because they were working so well that it would have been unethical to let them continue with men in control groups who were not given the medicine.

But a large trial involving African women of a vaginal gel containing an antiviral drug failed — apparently because 87 percent of the women in the trial were unable to use the gel regularly.

The failure of the cash-incentives trial was a surprise and a disappointment to scientists and advocates. It had paid out $2.8 million to 9,000 patients in 39 clinics over three years, but the clinics where money was distributed did only 5 percent better than those that did not — a statistically insignificant difference.

Some small clinics and those where patients had been doing poorly at the start of the study did improve as much as 13 percent, however.

People in other countries have been successfully paid to stop smoking while pregnant and to get their children to school. In Africa, paying poor teenage girls to attend school lowered their H.I.V. rates; scientists concluded that it eased the pressure on them to succumb to “sugar daddies” — older men who gave them money for food, clothes and school fees in return for sex.

One study presented here at the annual Conference on Retroviruses and Opportunistic Infections estimated that every prevented H.I.V. infection saved $230,000 to $338,000. Much of that cost is borne by taxpayers.

Mathematical modeling suggested that paying people up to $5,000 a year could be cost effective, Dr. El-Sadr said, but $280 was settled on after a long, difficult debate.

Paying more than $280 at some clinics was not an option, she said; achieving statistical relevance would have meant signing up even more clinics. The study had already involved almost every H.I.V. patient in the Bronx and Washington.

“I don’t think anyone has an answer to what amount would be sufficient without being excessive,” Dr. El-Sadr said.

One advocate suggested that more money could work — in the right setting.

“In South Africa, $280 is a lot of money,” said Mitchell Warren, the executive director of AVAC, an organization that lobbies for AIDS prevention. “For that much, you’d definitely get some behavior change.”

The two studies among gay men looked at different ways to take pills. A 2010 American study, known as iPrEx, showed that taking Truvada — a combination of two antiretroviral drugs — worked if taken daily.

The British study, known as PROUD, used that dosing schedule, and men who took the pill daily were protected 86 percent of the time.

In the French trial, known as Ipergay, men were advised to take two pills in the two days before they anticipated having sex and two in the 24 hours afterward.

Those who took them correctly also got 86 percent protection.

“The problem,” Dr. Susan P. Buchbinder, director of H.I.V. prevention research for the San Francisco health department, said in a speech here commenting on the study, “is that studies have shown that men are very good at predicting when they will not have sex and not good at predicting when they will.”

The African study, known as FACTS 001, was a follow-up to the smaller trial from 2010, which showed that South African women who used a vaginal gel containing tenofovir, an antiviral drug, before and after sex were 39 percent better protected than women who did not.

But it also found that many women failed to use the gel because it was messy or inconvenient or because partners objected.

In this trial, there was virtually no effect.

One problem, said Dr. Helen Rees, the chief investigator, was that the women were very young — the median age was 23, and most lived with their parents or siblings.

“They had no privacy for sex,” she said. “They had to go outside to use the product.”

Mr. Warren, of AVAC, said: “The women wanted a product they could use. But this particular product didn’t fit into the realities of their daily lives.”

The development means that advocates are hoping even more that other interventions for women now in trials will work. They include long-lasting injections of antiretroviral drugs and vaginal rings that can be inserted once a month and leach the drugs slowly into the vaginal wall.

Another trial in Africa, the Partners Demonstration Project, conducted among couples in which one partner had H.I.V. and the other did not, found it was extremely effective to simultaneously offer treatment to the infected partner and preventive drugs to the uninfected one until the other’s drugs took full effect.

In the group getting the treatment, there were zero infections that could be traced to partners who were in the study.

Source: www.nytimes.com

JESSICA FIRGER

Scientists have discovered a highly aggressive new strain of HIV in Cuba that develops into full-blown AIDS three times faster than more common strains of the virus. This finding could have serious public health implications for efforts to contain and reduce incidences of the virus worldwide.

Researchers at the University of Leuven in Belgium say the HIV strain CRF19 can progress to full blown AIDS within two to three years of exposure to virus. Typically, HIV takes approximately 10 years to develop into AIDS. Patients with CRF19 may start getting sick before they even know they've been infected, which ultimately means there's a significantly shorter time span to stop the disease's progression. 

The scientists began studying the cases in Cuba when reports began coming in that a growing number of HIV-infected patients were developing AIDS just three years after diagnosis with the virus. The findings of their study were published in the journal EBioMedicine.

Having unprotected sex with multiple partners can expose a person to numerous strains of the HIV virus. Research has found that when this occurs, the different strains can combine and form a new variant of the virus.

When HIV first enters the human body it latches on to anchor points of a certain protein, known as CCR5 on the cell membranes, which then allows it to enter human cells. Eventually the virus then latches onto another protein of the cell membrane, known as CXCR4. This marks the point when asymptomatic HIV becomes AIDS. In CRF19, the virus makes this move much sooner. 

For the study, the researchers analyzed blood samples of 73 recently infected patients. Among the group, 52 already had full-blown AIDS, while the remaining 21 were HIV-positive but the virus had not yet progressed. The researchers compared their findings to blood samples of 22 AIDS patients who had more common strains of the virus. 

The researchers found that patients with CRF19 had higher levels of the virus in their blood compared with those who had more common strains. 

They also had higher levels of the immune response molecules known as RANTES, which bond to CCR5 proteins in early stages of the virus. The abnormally high level of RANTES in patients infected with the new strain indicates that the virus runs out of CCR5 anchor points much earlier and moves directly to CXCR4 anchor points.

Thanks to advances in medical treatment and the development of highly effective antiretroviral drugs, HIV/AIDS is no longer a death sentence. But the researchers caution that patients with the new strain of the virus are more likely to be diagnosed when they already have full-blown AIDS and when damage from the disease has taken a toll.

The researchers suspect that this aggressive form of HIV occurs when fragments of other subsets of the virus cling to each other through an enzyme that makes the virus more powerful and easily replicated in the body.

There are currently 35 million people worldwide living with HIV/AIDS, according to the most recent data from the World Health Organization. Scientists have identified more than 60 different strains of the HIV 1 virus, with each type typically found predominantly in a specific region of the world.

Source: www.cbsnews.com

Gay men who've abstained from sex for one year would be able to donate blood in 2015, ending a lifetime ban for the gay community, under a proposed FDA policy change unveiled Tuesday.

The current lifetime ban by U.S. Food and Drug Administration states dates back to 1983 and forbids men who have had sex with men from becoming blood donors because the group is "at increased risk for HIV, hepatitis B and certain other infections that can be transmitted by transfusion," the FDA has ruled.

But the FDA is now seeking a change in that policy and would allow such blood donations based on an independent expert advisory panel's recommendation, the agency said.

The proposed change would align the one-year deferral period "with that of other men and women at increased risk for HIV infection," the FDA said.

The agency will be gathering public comments on the proposed change.

"We encourage all stakeholders to take this opportunity to provide any information the agency should consider, and look forward to receiving and reviewing these comments," FDA Commissioner Margaret A. Hamburg said in a statement.

The National Heart Lung and Blood Institute and the FDA would monitor a national blood surveillance system to see any effects of the proposed policy change and to ensure the continued safety of the blood supply, Hamburg said.

"A history of male-to-male sex is associated with an increased risk for exposure to and transmission of certain infectious diseases, including HIV, the virus that causes AIDS," the FDA said. Men who have had sex with other men represent approximately 2% of the U.S. population, yet are the population most severely affected by HIV, according to the FDA.

In 2010, male-to-male sex accounted for at least 61% of all new HIV infections in the United States, and "an estimated 77% of diagnosed HIV infections among males were attributed to male-to-male sexual contact," the FDA said.

Source: www.cnn.com

U.S. health officials are poised to endorse circumcision as a means of preventing HIV and other sexually transmitted diseases.

The U.S. Centers for Disease Control and Prevention on Tuesday released its first-ever draft guidelines on circumcision that recommend that doctors counsel parents and uncircumcised males on the health benefits of the procedure.

The guidelines do not outright call for circumcision of all male newborns, since that is a personal decision that may involve religious or cultural preferences, Dr. Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, told the Associated Press.

Discussion board is open for inputs on this subject.

But "the scientific evidence is clear that the benefits outweigh the risks," Mermin said.

Circumcision involves the surgical removal of the foreskin covering the tip of the penis. Germs can collect and multiply under the foreskin, creating issues of hygiene.

Clinical trials, many done in sub-Saharan Africa, have demonstrated that circumcision reduces HIV infection risk by 50 percent to 60 percent, the CDC guidelines note. The procedure also reduces by 30 percent the risk of contracting herpes and human papilloma virus (HPV), two pathogens believed to cause cancer of the penis.

The guidelines do point out that circumcision has only been proven to prevent HIV and sexually transmitted diseases in men during vaginal sex. The procedure has not been proven to reduce the risk of infection through oral or anal sex, or to reduce the risk of HIV transmission to female partners.

The scientific evidence is mixed regarding homosexual sex, the guidelines say, with some studies having shown that circumcision provides partial protection while other studies have not.

Circumcision does reduce the risk of urinary tract infections in infants, according to the CDC guidelines.

The most common risks associated with the procedure include bleeding and infection.

Male circumcision rates in the United States declined between 1979 and 2010, dropping from almost 65 percent to slightly more than 58 percent, according to a CDC report issued last year.

The new draft guidelines mirror an updated policy on circumcision released by the American Academy of Pediatrics in 2012.

"The American public should take confidence that these are pretty much converging guidelines. There is no doubt that it [circumcision] does confer health benefits and there is no doubt it can be performed safely, with a less than 1 percent risk of complications," Dr. Susan Blank, chair of the task force that authored the AAP policy statement, said Tuesday. "This is one thing a parent can do to protect the future health of their children."

In its policy statement, the AAP declared that the health benefits are great enough that infant male circumcision should be covered by insurance, which would increase access to the procedure for families who choose it, said Blank, who is also assistant commissioner of STD Control and Prevention at the New York City Department of Health and Mental Hygiene.

"The push from the academy's point of view is to really have providers lay out for parents what are the risks, what are the benefits, and give the parents the information they need to make a decision," Blank said. "And the academy feels strongly that since there are proven health benefits, the procedure should be covered by insurance."

The guidelines are expected to spur a response from anti-circumcision groups.

"There are certainly groups that are troubled by circumcision of an individual who is not in a position to provide their own consent," Blank said.

The public can comment on the draft guidelines through Jan. 16, according to the CDC.

Source: www.nlm.nih.gov

By Meera Senthilingam

"It only takes one virus to get through for a person to be infected," explained Dr. John Mascola. This is true of any viral infection, but in this instance, Mascola is referring to HIV and his ongoing efforts to develop a vaccine against the virus. "It's been so difficult to make an HIV/AIDS vaccine."

Those were the words of many working in HIV vaccine development until the results of a 2009 trial in Thailand surprised everyone. "The field is energized," said Mascola, director of the Vaccine Research Center at the U.S. National Institute of Allergy and Infectious Diseases, describing the change in atmosphere in the vaccine community.

The trial included over 16,000 volunteers and was the largest clinical trial ever conducted for a vaccine against HIV. It was also the first to show any protection at all against infection.

Two previously developed vaccines, known as ALVAC-HIV and AIDSVAX, were used in combination, with the first priming an immune response against HIV and the second used as a booster once the immunity waned. The duo reduced the risk of contracting HIV by 31.2% -- a modest reduction, but it was a start.

To date, only four vaccines have made it as far as testing for efficacy to identify their levels of protection against HIV. Only this one showed any protection.

"That trial was pivotal," Mascola said. "Prior to that, it wasn't known whether a vaccine could be possible."

In recent years, there have been parallel findings of an equally pivotal nature in the field of HIV prevention, including the discovery that people regularly taking their antiretroviral treatment reduce their chances of spreading HIV by 96% and that men who are circumcised reduce their risk of becoming infected heterosexually by approximately 60%.

Both improved access to antiretrovirals and campaigns to increase male circumcision in high-risk populations have taken place since the discoveries, and although numbers of new infections are falling, they're not falling fast enough.

In 2013, there were 35 million people estimated to be living with HIV globally. There were still 2.1 million new infections in 2013, and for every person who began treatment for HIV last year, 1.3 people were newly infected with the lifelong virus, according to UNAIDS. A vaccine remains essential to control the epidemic.

A complex beast

Scientists like Mascola have dedicated their careers to finding a vaccine, and their road has been tough due to the inherently complicated nature of the virus, its aptitude for mutating and changing constantly to evade immune attack, and its ability attack the very immune cells that should block it.

There are nine subtypes of HIV circulating in different populations around the world, according to the World Health Organization, and once inside the body, the virus can change continuously.

"Within an individual, you have millions of variants," explained Dr. Wayne Koff, chief scientific officer for the International AIDS Vaccine Alliance.

HIV invades the body by attaching to, and killing, CD4 cells in the immune system. These cells are needed to send signals for other cells to generate antibodies against viruses such as HIV, and destroying those enables HIV to cause chronic lifelong infections in those affected.

Measles, polio, tetanus, whooping cough -- to name a few -- all have vaccines readily available to protect from their potentially fatal infections. But their biology is seemingly simple in comparison with HIV.

"For the older ones, you identify the virus, either inactivate it or weaken it, and inject it," Koff said. "You trick the body into thinking it is infected with the actual virus, and when you're exposed, you mount a robust immune response."

This is the premise of all vaccines, but the changeability of HIV means the target is constantly changing. A new route is needed, and the true biology of the virus needs to be understood. "In the case of HIV, the old empirical approach isn't going to work," Koff said.

Scientists have identified conserved regions of the virus that don't change as readily, making them prime targets for attack by antibodies. When the success of the Thai trial was studied deep down at the molecular level, the protection seemed to come down to attacking some of these conserved regions. Now it's time to step it up.

In January, the mild success in Thailand will be applied in South Africa, where over 19% of the adult population is living with HIV. The country is second only to bordering Swaziland for having the highest rates of HIV in the world.

"The Thai vaccine was made for strains (of HIV) circulating in Thailand," said Dr. Larry Corey, principal investigator for the HIV Vaccine Trials Network, which is leading the next trial in South Africa. The strain, or subtype, in this case was subtype B. "For South Africa, we've formed a strain with common features to (that) circulating in the population." This region of the world has subtype C.

An additional component, known as an adjuvant, is being added to the mix to stimulate a stronger and hopefully longer-lasting level of immunity. "We know durability in the Thai trial waned," Corey said. If safety trials go well in 2015, larger trials for the protective effect will take place the following year. An ideal vaccine would provide lifelong protection, or at least for a decade, as with the yellow fever vaccine.

A broad attack

The excitement now reinvigorating researchers stems not only from a modestly successful trial but from recent successes in the lab and even from HIV patients themselves.

Some people with HIV naturally produce antibodies that are effective in attacking the HIV virus in many of its forms. Given the great variability of HIV, any means of attacking these conserved parts of the virus will be treasured and the new found gold comes in the form of these antibodies -- known as "broadly neutralizing antibodies." Scientists including Koff set out to identify these antibodies and discover whether they bind to the outer coat of the virus.

The outer envelope, or protein coat, of HIV is what the virus uses to attach to, and enter, cells inside the body. These same coat proteins are what vaccine developers would like our antibodies to attack, in order to prevent the virus from entering our cells. "Broadly neutralizing antibodies" could hold the key because, as their name suggests, they have a broad remit and can attack many subtypes of HIV. "We will have found the Achilles heel of HIV," Koff said.

Out of 1,800 people infected with HIV, Koff and his team found that 10% formed any of these antibodies and just 1% had extremely broad and potent antibodies against HIV. "We called them the elite neutralizers," he said of the latter group. The problem, however, is that these antibodies form too late, when people are already infected. In fact, they usually only form a while after infection. The goal for vaccine teams is to get the body making these ahead of infection.

"We want the antibodies in advance of exposure to HIV," explained Koff. The way to do this goes back to basics: tricking the body into thinking it is infected.

"We can start to make vaccines that are very close mimics of the virus itself," Mascola said.

Teams at his research center have gained detailed insight into the structure of HIV in recent years, particularly the outer coat, where all the action takes place. Synthesizing just the outer coat of a virus in the lab and injecting this into humans as a vaccine could "cause enough of an immune response against a range of types of HIV," Mascola said.

The vaccine would not contain the virus itself, or any of its genetic material, meaning those receiving it have no risk of contracting HIV. But for now, this new area remains just that: new. "We need results in humans," Mascola said.

Rounds of development, safety testing and then formal testing in high-risk populations are needed, but if it goes well, "in 10 years, there could be a first-generation vaccine." If improved protection is seen in South Africa, a first-generation vaccine could be with us sooner.

Making an Impact

When creating vaccines, the desired level of protection is usually 80% to 90%. But the high burden of HIV and potentially beneficial impact of lower levels of protection warrant licensing at a lower percentage.

"Over 50% is worth licensing from a public health perspective," Koff said, meaning that despite less shielding from any contact with the HIV virus, even a partially effective vaccine would save many lives over time.

The next generations will incorporate further advancements, such as inducing neutralizing antibodies, to try to increase protection up to the 80% or 90% desired.

"That's the history of vaccine research; you develop it over time," Corey said. He has worked in the field for over 25 years and has felt the struggle. "I didn't think it would be this long or this hard ... but it's been interesting," he ponders.

But there is light at the end of tunnel. Just.

"There has been no virus controlled without a vaccine," he concluded when explaining why, despite antiretrovirals, circumcision and increased awareness, the need for a one-off intervention like a vaccine remains strong.

"Most people that transmit it don't even know they have it," he said. "To get that epidemic, to say you've controlled it, requires vaccination."

Source: www.cnn.com

By GILLIAN MOHNEY

A girl believed to be “cured” of HIV at birth now has detectable levels of the virus, health officials said today.

The unnamed girl, dubbed the “Mississippi baby” after being born to an HIV-positive mother in 2010 and quickly treated with an intense dose of antiretroviral medication, showed no signs of the virus for roughly four years, according to the National Institute for Allergy and Infectious Disease. But a recent round of tests revealed detectable levels of HIV in her blood as well as antibodies to the virus and a decreased T-cell count -- all signs of the infection.

“Certainly, this is a disappointing turn of events for this young child, the medical staff involved in the child’s care, and the HIV/AIDS research community,” NIAID director Dr. Anthony Fauci said in a statement. “Scientifically, this development reminds us that we still have much more to learn about the intricacies of HIV infection and where the virus hides in the body.”

The case of the Mississippi baby made headlines across the globe after being published in the New England Journal of Medicine. Dr. Hannah Gay, the University of Mississippi Medical Center pediatrician who treated the infant at birth, was listed as one of Time magazine’s most influential people of 2013.

Gay's decision to give the newborn antiretroviral medication in the days before it was confirmed that she was in fact HIV-positive was controversial, since there was only a 25 percent chance that the girl would contract the virus from her mother.

The girl continued treatment for 18 months before her mother stopped taking her to her clinic appointments. Five months later, when she went back for a check-up, she surprised doctors with undetectable levels of the virus.

At first, Gay and her colleagues said the baby had been “functionally cured” of the virus, but later revised their language to “remission” to better convey that there was a chance the virus could rebound, they said at the time.

Although the girl's positive test results have been described as a disappointment, experts say her case still shows tremendous progress in treating the virus that causes AIDS.

“The fact that this child was able to remain off antiretroviral treatment for two years and maintain quiescent virus for that length of time is unprecedented,” Dr. Deborah Persaud, professor of infectious diseases at the John Hopkins Children’s Center in Baltimore, said in a statement released by NIAID. “Typically, when treatment is stopped, HIV levels rebound within weeks, not years.”

Persaud is one of the two pediatric HIV experts involved in the ongoing analysis of the case.

“This virus is amazingly recalcitrant,” said Fauci. “It’s in reservoirs, except we don’t know every place in the body where the reservoir is going to be.”

NIAID and the National Institute of Child Health and Human Development announced today that they would provide funding to analyze the unique case and will take the new findings into account during a new clinical trial.

Source: abcnews.go.com

By Associated Press

New York state can end its three-decade HIV crisis by the year 2020, Gov. Andrew Cuomo said Sunday as he announced an ambitious plan to deliver a knockout blow to the epidemic by boosting testing, reducing new infections and expanding treatment.

The governor said the state is aiming to reduce new HIV diagnoses to 750 by the end of the decade - about the same number of tuberculosis cases seen in New York City each year - down from 3,000 expected this year and 14,000 new cases of the disease in 1993. If the state is successful, it would be the first time the number of people living with HIV has gone down since the crisis began with the first widely reported cases in 1981.

"Thirty years ago, New York was the epicenter of the AIDS crisis," Cuomo said. "Today I am proud to announce that we are in a position to be the first state in the nation committed to ending this epidemic."

To expand treatment, the state's Department of Health has negotiated bulk rebates with three companies producing HIV drugs. The state is also taking steps to make it easier to get tested, changing how HIV cases are tracked to ensure patients continue to receive treatment, and boosting access to "pre-exposure" drugs that can help high-risk people avoid infection.

Cuomo did not offer an estimate of the cost of the plan, but said it would end up saving the state more than $300 million per year by 2020 by reducing the amount the state pays for medical care for those with HIV.

Groups that have long advocated for HIV patients praised the governor's announcement, saying it shows that efforts to fight the disease are paying off, and that a scourge that once seemed unbeatable can be successfully fought.

"We have the tools and know-how to end the AIDS epidemic in New York, the only question is whether we have the political will," said Jason Walker, an organizer at VOCAL-NY, which advocates for low-income HIV patients. "Even without a vaccine or cure, Cuomo understands that we can dramatically reduce new infections below epidemic levels and ensure all people living with HIV achieve optimal health."

While the state's plan may sound overly optimistic, the number of new HIV cases in New York has dropped nearly 40 percent in the last 10 years because of better, faster tests; access to condoms; public outreach campaigns and other initiatives. Meanwhile, those with the disease are living longer thanks to significantly more effective treatments.

The goal of bringing the disease to below epidemic levels "is ambitious," said Mark Harrington, executive director of the anti-HIV organization Treatment Action Group, but "grounded in reality."

Source: foxnews.com

New guidelines from the United States Public Health Service update the recommendations for the management of healthcare personnel with occupational exposure to HIV and the use of postexposure prophylaxis. 

The guidelines, published in the September issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, emphasize the immediate use of a postexposure prophylaxis regimen containing three or more antiretroviral drugs after any occupational exposure to HIV. 

The PEP regimens recommended in the guidelines encourage the consistent use of a combination of three or more antiretroviral agents, which are said to be better tolerated than those recommended in the previously published guidelines from 2005, for all occupational exposures to HIV. Eligible antiretrovirals are from the following six classes of drugs: nucleoside and nucleotide reverse-transcriptase inhibitors, nonnucleoside reverse-transcriptase inhibitors, protease inhibitors, a fusion inhibitor, an integrase strand transfer inhibitor and a chemokine (C-C motif) receptor 5 antagonist. 

The guidance eliminates the previous recommendation to assess the level of risk associated with individual exposures to help determine the appropriate number of drugs recommended for PEP. 

“Preventing exposures should be the leading strategy to prevent occupational HIV infections,” David Kuhar, MD, an author of the guidelines and a medical epidemiologist with the CDC’s Division of Healthcare Quality Promotion, said in a news release. “However, when exposure occurs, it should be considered an urgent medical concern and a PEP regimen should be started right away, ideally within hours of the potential exposure.”

Expert consultation should be sought, but not at the expense of delaying treatment, according to the guidelines. Exposed healthcare personnel taking HIV PEP should complete a full four-week regimen and undergo follow-up HIV testing, monitoring for drug toxicity and counseling, beginning with follow-up appointments within 72 hours of the exposure. 

If a newer fourth-generation HIV antigen/antibody combination test is used for follow-up testing, an option to conclude HIV testing at four months, rather than the recommended six months after exposure, is provided. Many of the revised recommendations are intended to make the PEP regimen better tolerated, increasing the possibility that healthcare personnel complete the full regimen. 

The guidelines were developed by an interagency Public Health Service working group comprised of representatives from the CDC, National Institutes of Health, FDA and the Health Resources and Services Administration, in consultation with an external expert panel. The updated revisions were based upon expert opinion. 

Many HCP exposures to HIV occur outside of health clinic hours of operation, and initial exposure management often is overseen by emergency physicians or other providers who are not experts in the treatment of HIV infection or the use of antiretroviral medications, according to the news release. As such, the updated guidelines should be distributed and made readily available to emergency physicians and other providers as needed.

Read the guidelines: www.jstor.org/stable/10.1086/672271

Source: Nurse.com