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 immune globulin (HBIG) 0.06 mL/kg IM and begin the hepatitis B vaccine series, as stated in 1 and 1. If previously vaccinated but with unknown antibody response, test for anti-HBs and administer HBIG and/or vaccine booster if needed. Blood tests should be done immediately to establish your baseline status for HIV and HBV. Follow-up testing is recommended at 6 weeks, 3 months, and 6 months. 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 the example answer guided by 1, 1, and 1. Prompt treatment significantly reduces these transmission risks. Key steps to take after the exposure include:
- Washing the wound with soap and water
- Reporting the incident and seeking medical attention
- Receiving PEP for HIV and hepatitis B as necessary
- Undergoing follow-up testing to monitor for infection
- Educating oneself on safe handling of sharps and standard precautions to prevent future exposures, as outlined in 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Risk of HIV and HBV Transmission
- The risk of HIV transmission through a needle stick injury is a significant concern for healthcare workers, as noted in the study by 2.
- According to 3, occupational exposure to blood/body fluids is associated with the risk of infection with blood-borne pathogens like HIV, HBV, and HCV.
- The study by 3 reported that 13 out of 37 seropositive sources were HIV positive, and 9 were HBV positive.
Post-Exposure Prophylaxis (PEP)
- PEP is an effective way to prevent HIV infection after a needle stick injury, as stated in the study by 2.
- The study by 3 reported that PEP was given to healthcare workers injured from seropositive sources, and antiretroviral therapy was started for those who sustained injuries from HIV-positive sources.
- The study by 4 compared the efficacy and safety of emtricitabine and tenofovir alafenamide versus emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis.
Prevention and Safety Measures
- Safety precautions, such as proper education and training, can help reduce the incidence of accidental needle stick injuries, as noted in the study by 2.
- The study by 5 found that first responders who perceived a higher risk of HIV infection were more likely to receive medical screening and post-exposure prophylaxis after a needle stick injury.
- The study by 3 reported that recent interventions by the infection control committee at their hospital reduced needle stick injuries considerably during intravenous line administration and glucose monitoring.
HBV Infection and Vaccination
- The study by 6 evaluated the safety and feasibility of HIV pre-exposure prophylaxis in individuals with active HBV infection and found that it can be safely provided to individuals with HBV infection if there is no evidence of cirrhosis or substantial transaminase elevation.
- The study by 3 reported that hepatitis B immunization booster was given to healthcare workers who were injured from HbsAg positive sources, and both hepatitis B immunoglobulin and hepatitis B vaccine were administered if the healthcare worker was antiHBs negative.