Clinical Manual for Management of the HIV-Infected ... - myCME.com

for treatment is appropriate, and be knowledgeable
about referral resources and mechanisms. If the patient
is using injection drugs, emphasize the fact that HIV
is readily transmitted by sharing needles and other
injection equipment and that reusing or sharing
needles and syringes can cause additional infections (eg,
endocarditis, hepatitis C). Assess the patient’s readiness
to change his or her drug injection practices, and refer
to drug treatment programs as appropriate. Refer to
an addiction counselor for motivational interviewing
or other interventions, if available. After completion
of substance abuse treatment, relapse prevention
programs and ongoing support will be needed. If the
patient continues to use needles, discuss safer needleuse
practices (Table 3) and refer to a needle exchange
program, if one is available, so that syringes and needles
are not reused. A partial listing of needle exchange sites
may be found at: http://www.nasen.org, although many
states either do not have or cannot list their facilities.
Local harm-reduction activists may be aware of specific
programs for obtaining clean needles and syringes.
Patient-education flyers on safer injection practices,
safer stimulant use, overdose prevention, and other
topics are available on the Midwest AIDS Education
and Training Center’s Web site at http://www.uic.edu/
depts/matec/resource.html.
Table 3. Needle-Use Practices to Reduce the Risk of HIV
Infection and Transmission
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Never reuse or share needles, syringes, water, or drug preparation
equipment. If there is a need to reuse syringe equipment, it should
be cleaned properly with bleach or water, with care taken not to
share the materials (eg, container, water) used for cleaning.
It is best to use only sterile syringes obtained from a reliable source
(pharmacy, needle exchange program). In addition, reusing one’s
own syringes can lead to various bacterial infections, abscesses, etc.
Use sterile or boiled water to prepare drugs. If unavailable, use clean
water from a reliable source, such as fresh tap water.
Use a new or disinfected container (cooker) and a new filter (cotton)
to prepare drugs. Cooking the drugs before injecting can reduce the
chances of transmitting HIV when sharing equipment.
Clean the skin around the injection site with a new alcohol swab
before injecting, and use a sterile or clean cotton pad to stop the
blood flow after injecting. Also, using a tourniquet when injecting
can help reduce damage to veins and assist the user in controlling
the shot and avoiding overdose.
Safely dispose of syringes after one use, either in a specially made
sharps container, or a clean detergent container. Many pharmacies
offer disposal programs for used syringes.
For patient flyers on safer injection practices, safer stimulant use,
overdose prevention, and other topics, go to http://www.uic.edu/
depts/matec/resource.html.
Section 2—Health Maintenance and Disease Prevention | 2–27
Noninjection Drug Use and Prevention of HIV
Transmission
Exposure to HIV through contaminated blood may
also occur during noninjection drug use; for example, by
sharing cocaine straws or sniffers through which cocaine
is inhaled. These straws can easily penetrate fragile nasal
mucosa and become contaminated with blood from one
user before being used by another individual, who may
then experience mucous membrane exposure or even a
cut or break in the mucous membrane from the bloody
object. Straws or sniffers should not be shared.
Tattoo, Piercing, and Acupuncture Equipment
Patients should be aware of the risk of contamination
of tattoo equipment, inks, and piercing equipment, and
avoid situations where they might either transmit HIV
or pick up other bloodborne pathogens.
Acupuncturists generally use sterile needles, but clients
should verify this before using their services.
Maternal-Infant HIV Transmission
HIV-positive women can have healthy pregnancies,
with good health outcomes for both mother and baby.
For this to occur, women must know their HIV status as
early as possible, preferably before becoming pregnant.
Although intervention to reduce the risk of perinatal
infection is most effective if begun early in pregnancy,
or preferably before pregnancy, it may be beneficial at
any point in the pregnancy, even as late as during labor.
For further information, see chapter Reducing Maternal-
Infant HIV Transmission.
Postexposure Prophylaxis for Nonoccupational HIV
Exposure
Postexposure prophylaxis (PEP) may be considered
for certain sexual exposures, sexual assaults, and
other nonoccupational exposures to HIV. As with
occupational PEP, a risk assessment must be completed
and antiretroviral therapy, if indicated, must be
started in a timely manner. The risks and toxicities of
antiretroviral drugs must be weighed against potential
benefits, and the client’s informed consent must
be obtained. For further information, see chapter
Nonoccupational Postexposure Prophylaxis.