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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 27  |  Issue : 2  |  Page : 131-134

Post-exposure prophylaxis of Human Immunodeficiency Virus (HIV) infection - A RIMS experience


Department of Microbiology, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Web Publication19-Nov-2013

Correspondence Address:
Ksh Mamta Devi
Department of Microbiology, Regional Institute of Medical Sciences, Imphal - 795 004, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.121588

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  Abstract 

Objective: Health care workers (HCW) are at risk of occupational exposure to HIV. The purpose of this study is to carry out post exposure prophylaxis (PEP) after exposure among self reported personals and analyze them. Materials and Methods: Two hundred and twenty five (225) cases of accidental exposure were self reported in the Department of Microbiology from January 2001 till December 2011. Relevant data were recorded and analyzed. HIV antibody testing was done for the status of the source person. A baseline testing for HIV antibody was done before giving PEP. Post exposure testing was done at 3 months and at 6 months. PEP was given as per NACO guidelines. Results: Out of the 225 cases, maximum exposure (109 cases) happened in the age group of 25-34 years. Males were more exposed than females. Majority of the cases (38.6%) reported were doctors followed by nurses (23.1%), laboratory technicians (5.3%) and grade 4 workers (3.1%). 29.7% were outsiders. 39.1% cases reported in less than 2 hours after exposure, 57.7% reported between 2 to 72 hours and 3.1% took more than 72 hours. 59.5% of exposed population were vaccinated against Hepatitis B. Needle stick injury was the commonest form of exposure (65%), followed by spillage and splash (15%), sexual exposure ( 17%), human bite (2.6%) and sharp cut (2.2%). All post exposure testing were found to be non reactive. Conclusion: Needle prick injury is the most common cause of occupational exposure to HIV infection. PEP is protective against transmission of HIV among the exposed HCWs. There is a need for sensitising the HCWs regarding the importance of PEP.

Keywords: HIV, Occupational exposure, PEP


How to cite this article:
Devi KM, Singh H R, Devi KS, Singh NB. Post-exposure prophylaxis of Human Immunodeficiency Virus (HIV) infection - A RIMS experience. J Med Soc 2013;27:131-4

How to cite this URL:
Devi KM, Singh H R, Devi KS, Singh NB. Post-exposure prophylaxis of Human Immunodeficiency Virus (HIV) infection - A RIMS experience. J Med Soc [serial online] 2013 [cited 2019 Dec 14];27:131-4. Available from: http://www.jmedsoc.org/text.asp?2013/27/2/131/121588


  Introduction Top


With the increasing spread of Human Immunodeficiency Virus (HIV) infection there is increase in exposure to HIV among the health care workers (HCW). Inspite of taking universal precautions, accidents do happen. The absence of a vaccine or effective curative treatment makes the exposed person apprehensive. Post exposure prophylaxis (PEP) is a medical response to prevent transmission of pathogens after potential exposure and refers to comprehensive management instituted to minimize the risk of infection following potential exposure to blood pathogens. It includes first aid, counseling, risk assessment, relevant laboratory investigations based on informed consent of the exposed person and source person and depending on the risk assessment, the provision of short term (28 days) antiretroviral therapy (ART), along with follow up evaluation. [1],[2] Health care workers (HCW) are at risk of occupational exposure to blood borne pathogens. The average risk of transmission of HIV to a HCW after percutaneous exposure to HIV infected blood has been estimated as 0.3% [3],[4] and after mucous membrane exposure is 0.09%. [5]

There are limited literatures available in Indian context about the PEP usage and outcome in HIV setting. The exact magnitude of the problem of exposure in Indian population is not known. Hence the present study was undertaken to analyze the self reported cases of occupational and non occupational exposure to blood or body fluids.


  Materials and Methods Top


Over a period of 10 years, from January 2001 to December 2011 a total number of 225 cases of accidental exposure were self reported in the Department of Microbiology. Relevant data were recorded regarding personal details of the person exposed, history of Hepatitis B vaccination, place of work, occupation, time of exposure, time of reporting, type of exposure and immediate precautions taken at the time of exposure.

HIV antibody testing was done for the status of the source person. A baseline testing for HIV antibody was done using ELISA/RAPID tests as per NACO guidelines. [2] Post exposure testing for HIV antibody was done at 3 months and at 6 months. All HIV testing were done after taking informed consent. Pretest and post test counseling was given.

Basic regimen was given with zidovudine and lamivudine. Expanded regimen with zidovudine, lamivudine and indinavir. PEP was given as per NACO guidelines. Persons exposed were followed up for the side effect and tolerance of PEP. Confidentiality was maintained to respect the privacy and rights of the individual. All necessary precautions were taken to protect them from discrimination, victimization and stigmatization.


  Results Top


A total of 225 self reported cases of accidental exposure were analyzed. Out of 225 cases 158 were HCWs and 67 were outsiders. Maximum exposure (109 cases) happened in the age group of 25-34 years. Around 77% of exposures happened below the age group of 34 years. Fifty six point eight per cent (56.8%) of the cases were males and 43.1% were females. Majority of the cases (38.6%) reported were doctors (physician, surgeon, undergraduates and interns) followed by nurses (23.1%), laboratory technicians(5.3%) and grade 4 workers (3.1%). 29.7% were outsiders. 39.1% of exposed population were prompt in reporting in less than 2 hours. Around 57.7% exposed population took more than 2 hours and less than 72 hrs in reporting. Only 3.1% took more than 72 hrs in reporting. 59.5% of exposed population were vaccinated against Hep B, 16 % were not vaccinated and 24.4% could not recall. Needle stick injury was the commonest form of exposure ( 65%)-, followed by spillage and splash (15%)-, sexual exposure (17%), human bite (2.6%) and sharp cut (2.2%) [Table 1].
Table 1: Demographic profile of exposed personal

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Regarding the type of contact, out of 225 cases 146(64.8%) had contact with blood, 39 cases (17.3%) with vaginal secretions, 6 cases (2.6%) with saliva, 2 cases (0.8%) with pleural fluid, and type of contact was not specified with 32 cases (14.2%) as shown in [Table 2]. Of the 225 cases, HIV status was known in 127 cases and unknown in 98 cases. From the known sources, 65 cases were seropositive for HIV antibody.
Table 2: Status of the source

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Baseline HIV testing was done in 225 cases. All cases (100%) were found to be non reactive. Only 210(93.3%) cases out of 225 turned up for post exposure testing at 3 months and 195(86.6%) cases turned up for post exposure testing till 6months. Fifteen cases did not turn up for the post exposure testing at 6 months. All post-exposure testing were found to be non-reactive.

PEP basic regimen was given to 144 cases (64%), while expanded regimen was given to 14 cases (6.2%). No PEP was recommended to 67 cases (29.7%). Side effects of PEP were complained by 71 persons (31.5%). Out of 71 cases, 44 of them complained of nausea, 23 cases of mayalgia and fatigue, while 4 cases had mild headache as shown in [Table 3].
Table 3: Status of the exposed personals after PEP

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  Discussion Top


The risk of transmission of HIV to a health care worker after per cutaneous exposure to HIV-infected blood is 0.3%, [3],[4] which is very low. Our study did not report any HIV- positive case after exposure.

Most of the cases (56.8%) were males which shows male vulnerability in contrast to the study of Shevkani et al. [6] In our study, maximum exposure (109 cases) happened in the age group of 25-34 years. Around 77% of exposures happened below the age group of 34 years which is similar to the study of others. [6] This can be a reflection of larger number of exposure prone procedures conducted by this age group. Majority of the cases (38.6%) reported were doctors ( physicians, surgeons, undergraduate students and interns) followed by nurses (23.1%), laboratory technicians (5.3%) and grade 4 workers (3.1%). 29.7% of the cases were outsiders. Among HCWs, resident doctors have the highest exposure as compared to nurses, interns, technicians. [7],[8] In other studies, nurses had the maximum exposure. [6],[9] This shows that there is more awareness among the doctors as compared to nurses and housekeeping staff. Besides this it is also likely that due to ignorance there will be other healthcare workers who may not be reporting the exposures to the authorities and in turn may not have access to PEP. They are all highly vulnerable for increased risk for acquiring blood-borne HIV exposures in health care settings. [9],[10]

Thirty nine point one percent (39.1%) of exposed population were prompt in reporting in less than 2 hours. Around 57.7% exposed population took more than 2 hours and less than 72 hrs in reporting. Only 3.1% took more than 72 hrs in reporting. Reporting was more prompt in other study, [6] which showed 56.8% cases being reported within 2 hours of exposure. PEP is most effective if administered soon after exposure within 2 hours. [2]

Needle stick injury was the commonest form of exposure (65%), followed by spillage and splash (15%), sexual exposure (17%), human bite (2.6%) and sharp cut (2.2%).Needle stick injury is the most common source of occupational exposure to infected blood and body fluids as reported by the worker. [8]

One encouraging fact was that baseline HIV testing was done in 225 cases. All cases(100%) were found to be non reactive. Only 85% had their baseline testing in another study. [6]

PEP is the cost-effective measurements in low and middle income countries in HIV settings for HCW getting exposed to infectious materials. [10] PEP basic regimen was given to 144 cases (64%), expanded regimen to 14 cases (6.2%) but no PEP was recommended to 67 cases (29.7%). Only 210(93.3%) cases out of 225 turned up for post exposure testing at 3 months and 195(86.6%) cases turned up for post-exposure testing at 6months. All post exposure testing were found to be non-reactive like other study. [13] This may be due to timely institution of effective PEP.

Side-effects of PEP were complained by 71 persons (31.5%). Out of 71 cases, 44 of them complained of nausea, 23 cases of mayalgia and fatigue while 4 cases had mild headache as shown in [Table 3]. Side-effects were mild and they could tolerate with it with symptomatic treatment. Detailed counseling is required for better mental preparation for post-PEP outcome.

Thus, it is important for the HCWs to know how to prevent injuries. If exposed, they should report to the relevant authority to get the facility of PEP. Facility of PEP should be made available round the clock in all health care institutions. It must be noted that PEP is not cent percent effective in preventing HIV seroconversion. [11] Therefore, PEP cannot be considered to replace the universal precautions and avoiding occupational injuries. Persons who take PEP and are under follow up for 6 months should abstain from any high-risk behavior activity and not donate blood. [13]


  Conclusion Top


The present study shows that needle prick injury is the most common cause of occupational exposure to HIV infection. PEP is protective against transmission of HIV among the exposed HCWs. There is a need for sensitizing the HCWs regarding the importance of PEP after occupational and non-occupational exposure to HIV. Timely reporting after exposure of the HCW is indeed the need of hour to avail the facility of PEP, and the authority has responsibility to provide the facility to all the HCW.


  Acknowledgement Top


We acknowledge Mr. Sandeep Pandey, Clinical Resource Consultant, BD Medical for helping us in discussion.

 
  References Top

1.Sharma A, Marfatiya YA, Ghiya R. Post-exposure prophylaxis for HIV. Indian J Sex Trans Dis 2007;28:2.  Back to cited text no. 1
    
2.National AIDS control organisation. Management of occupational exposure including Post-exposure prophylaxis for HIV. NACO, Ministry of Health and Family Welfare, Govt. of India, New Delhi; 2000.  Back to cited text no. 2
    
3.Gerberding JL. Incidence and prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and cytomegalovirus among health care personnel at risk for blood exposure: Final report from a longitudinal study. J Infect Dis 1994;170:1410-7.  Back to cited text no. 3
[PUBMED]    
4.Bell DM. Occupational risk of Human Immunodeficiency Virus infection in health care workers: An overview. Am J Med 1997;102: 9-15.  Back to cited text no. 4
[PUBMED]    
5.Impolite G, Puro V, De Carli G. The Italian study on occupational risk of HIV infection in HCWs. Arch Intern Med 1993:153:1451-58.  Back to cited text no. 5
    
6.Shevkani M. Kavina B, Kumar P, Purohit H, Nihalani U, Shah A. An overview of Post-exposure prophylaxis for HIV in health care personals: Gujarat scenario. Indian J of Sex Trans Dis 2011,32:9-13.  Back to cited text no. 6
    
7.O'Neill TM, Allan V, Radeeski A. Risk of needle sticks among residents and medical students. Arch Intern Med 1992:152:1451-56.  Back to cited text no. 7
    
8.Rele M, Mathur M, Turbadkar D. Risk of needle sticks in health care workers - a report. Indian J Med Microbiol 2002;20:206.  Back to cited text no. 8
    
9.Baheti AD, Tullu MS, Lahiri KR. Awareness of health care workers regarding prophylaxis for prevention of transmision of blood borne viral infections in occupational exposures. Al Amen J Med Sci 2010;3:79-83.  Back to cited text no. 9
    
10.Gupta A, Anand S, Sastry J, Krisagar A, Basavaraj A, Bhat SM, et al. High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, India. BMC Infect Dis 2008;21:142.  Back to cited text no. 10
    
11.Mehta A, Rodrigues C, Singhal T, Lopes N, D'Souja N, Sathe K, et al. Interventions to reduce needle stick injuries at a tertiary care centre. Indian J Med Microbiol 2010;28:17-20.  Back to cited text no. 11
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12.Young TN, Arens FJ, Kennedy GE, Laurie JW, Rutherford G. Antiretroviral post exposure prophylaxis (PEP) for occupational HIV exposure. Cochrane Database Syst Rev 2007;1:CD002835.  Back to cited text no. 12
    
13.Merchant RC, Keshavarz R. Human Immunodeficiency virus postexposure prophylaxis for adolescents and children. Paediatrics 2001;108:38.  Back to cited text no. 13
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Materials and Me...
Results
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