From the Guidelines
If you experience a needlestick injury from a patient who is HIV and HBsAg positive, you should immediately wash the wound thoroughly with soap and water, then seek urgent medical attention for post-exposure prophylaxis (PEP). For HIV exposure, start PEP ideally within 2 hours but no later than 72 hours after exposure, as recommended by 1. The recommended regimen is typically a three-drug combination such as tenofovir disoproxil fumarate (TDF) 300mg plus emtricitabine (FTC) 200mg once daily, plus dolutegravir 50mg once daily for 28 days. For hepatitis B exposure, if you're not immune (unvaccinated or non-responder), you should receive hepatitis B immunoglobulin (HBIG) 0.06 mL/kg intramuscularly and begin the hepatitis B vaccination series, as stated in 1 and 1. If you've been previously vaccinated but your antibody status is unknown, get tested for anti-HBs and receive a booster dose of the vaccine. Report the incident to your occupational health department immediately for proper documentation, risk assessment, and follow-up testing. The risk of HIV transmission from a needlestick is approximately 0.3%, while HBV transmission risk is much higher at 6-30% if the source is HBeAg positive, as mentioned in 1. Follow-up testing should be conducted at baseline, 6 weeks, 3 months, and 6 months to monitor for potential infection. Key steps to take after the exposure include:
- Washing the wound with soap and water
- Seeking urgent medical attention for PEP
- Receiving HBIG and hepatitis B vaccination series if not immune
- Getting tested for anti-HBs and receiving a booster dose if previously vaccinated but antibody status is unknown
- Reporting the incident to the occupational health department
- Undergoing follow-up testing to monitor for potential infection, as outlined in 1, 1, and 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Needle Stick Injury from a Patient with HIV and HBsAg Positive
- A needle stick injury from a patient with HIV and HBsAg positive can lead to infections, including HIV and hepatitis B 2, 3, 4.
- The risk of transmission of HIV and hepatitis B through a needle stick injury can be minimized by following proper safety protocols and post-exposure prophylaxis (PEP) 2, 3, 4.
- The current CDC recommendations for HIV infection treatment are antiretroviral therapies, such as an HIV postexposure prophylaxis regimen, which consists of a cocktail of antiretrovirals and postexposure prophylaxis immediately for occupational exposures, such as accidental needlestick exposure from an HIV infected patient 2.
- For individuals with active hepatitis B, pre-exposure prophylaxis (PrEP) with daily oral emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) can be safely provided if there is no evidence of cirrhosis or substantial transaminase elevation 5.
- Emtricitabine and tenofovir alafenamide (TAF) has been shown to be non-inferior to emtricitabine and tenofovir disoproxil fumarate (TDF) for HIV prevention, with more favorable effects on bone mineral density and biomarkers of renal safety 6.
Management of Needle Stick Injuries
- The management of needle stick injuries involves immediate reporting, post-exposure prophylaxis, and follow-up testing for HIV and hepatitis B 3, 4.
- The use of safety precautions, such as gloves and safe needle handling, can reduce the risk of needle stick injuries 3, 4.
- Education and training on the proper management of needle stick injuries are essential for healthcare workers 2, 3, 4.
Post-Exposure Prophylaxis
- Post-exposure prophylaxis (PEP) is an effective way to prevent HIV infection after a needle stick injury 2, 3, 4.
- PEP should be initiated as soon as possible after the exposure, ideally within 24 hours 3.
- The completion rate of PEP is crucial to prevent HIV infection, and healthcare workers should be educated on the importance of completing the full course of treatment 3.