What should I do if I have blood exposure from an HIV positive individual?

Blood Exposure from HIV-Positive Individual: Immediate Management Protocol

Immediately wash the exposed skin area thoroughly with soap and water, then seek emergency medical evaluation within 1 hour to initiate post-exposure prophylaxis (PEP), which must be started within 72 hours to be effective. 1, 2

Immediate First Aid (Within Minutes)

• Wash the exposed area thoroughly with soap and water - this is the single most critical first step 3, 1, 2
• Do NOT squeeze, scrub, or apply pressure to increase bleeding 1
• If blood splashed into eyes, nose, or mouth, flush immediately with clean water or saline 3, 2
• Document the time of exposure immediately, as timing is critical for PEP effectiveness 1, 4

Emergency Medical Evaluation (Within 1 Hour)

Time is critical: PEP effectiveness drops dramatically after 72 hours, with optimal results when started within the first hour. 1

Risk Assessment for Intact vs Non-Intact Skin

• Intact skin exposure: The risk of HIV transmission through intact skin is virtually non-existent if washed within 15 minutes 5
• Non-intact skin (cuts, abrasions, chapped skin, dermatitis): Higher risk and may warrant PEP consideration 2, 5
• The actual transmission risk from blood exposure on non-intact skin is significantly lower than percutaneous needlestick injury (which is only 0.3-0.36%) 1, 6, 7

When to Initiate PEP

For non-intact skin exposure to blood from a known HIV-positive source, PEP should be considered and initiated immediately, even before complete risk assessment. 1, 2

• Start PEP within 1 hour if possible, absolutely within 72 hours 1
• Do not wait for source patient testing results to begin treatment 1, 8
• PEP reduces HIV transmission risk by approximately 81% when started promptly 1, 7

Recommended PEP Regimen

The preferred regimen is bictegravir/emtricitabine/tenofovir alafenamide (single tablet once daily) for 28 days. 1

Alternative combinations include: 1

• Dolutegravir plus tenofovir alafenamide/emtricitabine
• Dolutegravir plus tenofovir disoproxil fumarate/lamivudine

Complete the full 28-day course - stopping early eliminates all protection. 1

Testing Protocol

Baseline Testing (Day 0)

• HIV antibody or antigen/antibody combination test 1, 4
• Hepatitis B surface antigen (HBsAg) and serology 1, 4
• Hepatitis C antibody (anti-HCV) 1, 4
• Complete blood count, renal and hepatic function (if starting PEP) 4
• Pregnancy test if applicable 4

Source Patient Testing

• HIV antibody (rapid testing preferred for quick decision-making) 3, 1, 4
• Hepatitis B surface antigen 3, 4
• Hepatitis C antibody 3, 4

Follow-Up Testing Schedule

• HIV testing: at 6 weeks, 3 months, and 6 months post-exposure 3, 1, 4
• Hepatitis C: anti-HCV and ALT at 4-6 months; consider HCV RNA at 4-6 weeks for earlier diagnosis 3, 4
• Hepatitis B: If vaccine given, test anti-HBs 1-2 months after final dose 3, 4
• PEP monitoring: Evaluate within 72 hours of starting, then monitor for drug toxicity every 2 weeks 3, 1, 4

Hepatitis B Management

If you are unvaccinated or incompletely vaccinated and the source is HBsAg-positive: 1, 2

• Administer hepatitis B immune globulin (HBIG) within 24 hours (can give up to 7 days) 2
• Begin hepatitis B vaccine series immediately 1, 2
• Risk of HBV transmission without prophylaxis can exceed 30% 1, 4

Hepatitis C Considerations

• No post-exposure prophylaxis exists for hepatitis C 3, 1, 2
• Transmission risk is approximately 1.8% from percutaneous exposure 1, 4
• Early identification through testing is the only approach 1, 2

Precautions During Follow-Up Period

For 6 months post-exposure: 1

• Use barrier protection during all sexual activity 1
• Do not donate blood, plasma, organs, tissue, or semen 1
• Seek immediate medical evaluation for any acute illness (may indicate acute retroviral syndrome) 3, 1, 2

Common Pitfalls to Avoid

• Delaying washing: The 15-minute window for washing is critical for reducing transmission risk 5
• Waiting for source testing before starting PEP: Always start immediately if indicated, then reassess 2-4 days later 8
• Incomplete PEP course: Stopping antiretrovirals early eliminates all protective benefit 1
• Missing follow-up testing: HIV can take up to 6 months to become detectable 3, 1
• Assuming intact skin is safe without washing: Even intact skin requires immediate thorough washing 2, 5

Documentation Requirements

Document immediately: 3, 4, 2

• Date and time of exposure
• Type of fluid (blood) and volume
• Condition of skin (intact vs non-intact)
• Source patient HIV status if known
• All interventions and timing