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474 HIV/AIDS TREATMENT AND CARE CLINICAL PROTOCOLS FOR THE WHO EUROPEAN REGION • If the exposure source is unknown, cannot be tested or refuses to be tested, the risk of HIV transmission should be assessed epidemiologically, if possible. Relevant information includes: ° type of exposure ° prevalence of HIV in the population where the source material originates. • If the source person is known to have HIV infection, the following information is also useful to know in determining an appropriate PEP regimen: ° clinical stage of the HIV infection; ° CD4 cell count; ° viral load, as a high plasma viral load increases the risk of transmission in all cases (27); ° antiretroviral treatment history; ° genotypic or phenotypic viral resistance results (if available); ° in a case of sexual exposure, the existence of genito-oral ulcers or other sexually transmitted infections (STIs), and whether menstruation or other bleeding occurred at the time (24); and ° in the case of an accidental needle-stick exposure, whether fresh blood was present and whether it was a deep injury or intravenous injection (all increase the risk of HIV transmission) (6). • If this information is not immediately available, initiation of PEP, if indicated, should not be delayed. Appropriate changes in the PEP regimen can be made if new information emerges after PEP has been started. • If the source person’s results are HIV seronegative at post-exposure evaluation and presents no clinical evidence of AIDS or HIV infection, no further testing of the source is indicated. The likelihood of the source person being in the “window period” of HIV infection with no symptoms of acute retroviral syndrome is extremely small. 3. Evaluation of the exposed person Evaluation of exposed persons (regardless if it is occupational or non-occupational) has to be done as soon as possible and within hours after an exposure. The following evaluations are recommended: • an HIV serological baseline test to establish infection status at the time of exposure, with preand post-test counselling and based on informed consent (see Annex 2); • direct virus assays for any exposed person who has an illness compatible with an acute retroviral syndrome, regardless of the time elapsed since exposure; • evaluation of circumstances, medical conditions and medications that might influence drug selection for PEP (e.g. pregnancy or breastfeeding); It is useful to perform the following baseline tests if resources are available: • baseline laboratory testing to monitor for adverse reactions: ° complete blood count (CBC) with differential and platelets ° liver function tests (LFTs) (asparate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin) ° urea or serum creatinine; and • baseline serological tests for hepatitis C and B (HCV antibodies and hepatitis B surface antigen (HBsAg)). 3.1. Additional considerations for non-occupationally exposed people In addition, those seeking care after potential non-occupational exposure to HIV should also be evaluated for the following information: • frequency of exposures to HIV; • history of specific sexual, drug-injecting or other behaviours that might have heightened the risk for acquiring HIV infection; • if an accidental needle-stick exposure, whether there was fresh blood and whether it was a deep injury or intravenous injection (6); and • if a sexual exposure:
° condom use ° presence of STIs (as determined by testing) ° need for emergency contraception or pregnancy testing (for females) ° presence of sexual assault, by one or more persons ° whether menstruation or other bleeding was present at time of exposure. post-exposure prophylaxis for hiv infection 475
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HIV/AIDS TREATMENT AND CARE Clinica
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© World Health Organization 2007 A
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iv Acknowledgements The editors wou
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vi Marco Vitoria (WHO headquarters)
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viii CRP C-reactive protein CS caes
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x LFT liver function test LGE linea
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xii TDM therapeutic drug monitoring
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xiv Introduction HIV is a chronic i
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Annex 7. Glossary .................
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HIV/AIDS TREATMENT AND CARE CLINICA
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HIV/AIDS TREATMENT AND CARE CLINICA
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10 HIV/AIDS TREATMENT AND CARE CLIN
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1 HIV/AIDS TREATMENT AND CARE CLINI
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I. Principles management of opportu
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management of opportunistic infecti
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Table 8. pcp second-line treatment
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Table 12. oesophageal and dissemina
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5.9.1.2. Treatment Table 15. treatm
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palliative care for people living w
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III. Initial evaluation palliative
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IV. Treatment palliative care for p
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Fig. 2. who analgesic ladder for ma
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Type of pain or treatment Usual sta
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Table 5. prevalence of symptoms in
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Type Symptoms Possible causes Disea
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Type Symptoms Possible causes Disea
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Table 22. Management of mania and B
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Table 24. Management of cough or di
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V. Special advice for terminal care
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Table 27. common manifestations in
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References palliative care for peop
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VI. Suggested minimum data to be co
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136 HIV/AIDS TREATMENT AND CARE CLI
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Contents I. Policy and principles .
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I. Policy and principles HIV/AIDS T
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HIV/AIDS TREATMENT AND CARE FOR INJ
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° bacterial pneumonia ° endocardi
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Social factors are: • homelessnes
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Table 3. Interactions between ARV d
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Other medications Use Rifampicin (R
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Table 5. Interactions of illicit dr
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ANNEX 1 ASI6 C © 2004 University o
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• Cardiovascular Hypertension Tac
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Contents I. Epidemiology and natura
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ManageMent of Hepatitis C and HiV C
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Annex 3. Alcohol screening question
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Table 16. a sample of the drug pipe
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3.2. Considerations regarding treat
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278 hiv/aids tReatment and caRe cLi
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I. Prevention strategies Prevention
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Prevention of HePatitis a, B, C and
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Prevention of HePatitis a, B, C and
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5. Contraceptive methods for women
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I. Policy issues Prevention of Hiv
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III. Initial evaluation Prevention
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Prevention of Hiv transmission from
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6. Fungal infections...............
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