Immediate HIV Post-Exposure Prophylaxis for Occupational Blood Exposure
Your husband needs to start 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
Immediate Actions (First Hour)
Wash the exposure site thoroughly with soap and water right now. 2, 1 If blood splashed into eyes, nose, or mouth, flush immediately with clean water or saline. 1 Do not squeeze or apply pressure to increase bleeding. 1
Seek emergency medical evaluation within 1 hour to initiate PEP. 1 The sooner PEP is started, the more effective it is—effectiveness drops dramatically after 72 hours. 1 Even though the actual risk of HIV transmission from a needlestick with HIV-infected blood is approximately 0.3% (3 per 1,000 exposures), PEP reduces this risk by approximately 81% when started promptly. 1
Report the incident to his supervisor immediately and document: 1
- Date and time of exposure
- Type of exposure (percutaneous injury, mucous membrane, or intact/non-intact skin contact)
- Type of fluid (blood, visibly bloody fluid)
- Extent of injury
- Source patient's HIV status (known positive in this case)
PEP Medication Regimen
The preferred regimen is bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF)—a single tablet taken once daily for 28 days. 1, 3 This is the CDC's top recommendation. 3
Alternative preferred regimen: Dolutegravir 50mg daily plus emtricitabine/tenofovir alafenamide (Descovy) daily. 3
Critical: Do not delay PEP initiation while awaiting additional testing or expert consultation—start immediately with the preferred regimen. 3 If there's any question about which drugs to use, start the basic regimen immediately rather than delay. 2
Complete the full 28-day course. 2, 1, 3 Stopping early eliminates protection. 1
Testing Protocol
Baseline testing (before starting PEP): 1, 3
- HIV antigen/antibody combination test (rapid testing preferred)
- Hepatitis B serology (HBsAg)
- Hepatitis C antibody (anti-HCV)
- Renal function (creatinine, eGFR)
- Complete blood count
- Hepatic function tests
Follow-up HIV testing schedule: 2, 1, 3
- 4-6 weeks post-exposure
- 3 months post-exposure
- 6 months post-exposure
Hepatitis C testing: 1
- 4-6 months post-exposure
- Consider HCV RNA at 4-6 weeks for earlier diagnosis
Hepatitis B Management
If your husband is unvaccinated or incompletely vaccinated for hepatitis B, he needs hepatitis B immune globulin (HBIG) immediately and should start the hepatitis B vaccine series. 1 The risk of hepatitis B transmission without prophylaxis can exceed 30%. 1
Monitoring During PEP
Monitor for drug toxicity every 2 weeks during the 28-day PEP course: 2, 1
- Complete blood count
- Renal function tests
- Hepatic function tests
Reevaluate within 72 hours of starting PEP. 1, 3
Common side effects (nausea, diarrhea) can be managed with antimotility and antiemetic agents without changing the regimen. 2 Do not stop PEP due to manageable side effects—consult with the prescribing physician for symptom management. 2
Seek immediate medical evaluation for: 2
- Rash
- Fever
- Back or abdominal pain
- Pain on urination or blood in urine
- Symptoms of hyperglycemia (increased thirst/frequent urination)
- Any acute illness (may indicate acute retroviral syndrome)
Precautions During Follow-Up Period
For the next 6 months, your husband should: 2, 1
- Use barrier protection (condoms) during sexual activity
- Not donate blood, plasma, organs, tissue, or semen
- Seek immediate medical evaluation for any acute illness (fever, rash, myalgia, fatigue, malaise, lymphadenopathy)
Critical Pitfalls to Avoid
Do not wait for source patient confirmation before starting PEP. 3 Since the source is known to be HIV-positive, this is a clear indication for immediate PEP. 2
Do not use salvage therapy agents (like fostemsavir) for PEP. 3 These are only for treatment-experienced patients with multidrug-resistant HIV. 3
Do not delay beyond 72 hours. 2 While animal studies suggest PEP is substantially less effective when started more than 24-36 hours post-exposure, it should still be initiated even after 36 hours for high-risk exposures. 2
Pregnancy does not preclude PEP use. 2 If applicable, this should be discussed but should not delay initiation. 2
Expert Consultation Resources
National Clinicians' Post-Exposure Prophylaxis Hotline (PEPline): 1-888-448-4911 2 This resource is available 24/7 for consultation on complex PEP cases. 2
Counseling and Support
Access to counseling is essential. 2 The emotional impact of occupational HIV exposure is often substantial, even though the actual transmission risk is low. 2 Healthcare facilities should provide counseling for the emotional effects and medication adherence support. 2
His patient-care responsibilities do not need to be modified based solely on this HIV exposure. 2