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Management of HIV - Post-Exposure Prophylaxis Management of HIV - Post-Exposure Prophylaxis

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Occupational Exposure Management of HIV Post-Exposure Prophylaxis Bruce D. Agins, MD MPH Medical Director, AIDS Institute New York State Department of Health
Overview ,[object Object],[object Object],[object Object]
RATIONALE ,[object Object],[object Object],[object Object]
Occupational HIV Infection ,[object Object],[object Object],[object Object],[object Object],[object Object]
Occupational HIV Infection ,[object Object],[object Object],[object Object],[object Object]
U.S. Health-Care Workers with Documented Occupationally Acquired HIV Infection, by Occupation through June 1999 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Source Fluids for Exposures Resulting in Occupational HIV Transmission US HCW reported through 12/98
Risk Factors for HIV Transmission CDC Case Control Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Exposure Risk ,[object Object],[object Object],[object Object]
Exposure Risk ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Rationale for PEP: The Science ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Outcomes of HIV Exposures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Animal Studies of PEP: Prevention of SIV in macaques with Tenofovir (PMPA) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Tsai et al, J Virol, 1998;72:4265
Animal Studies of PEP: Prevention of SIV in macaques with Tenofovir (PMPA) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Tsai et al, J Virol, 1998;72:4265
Animal Studies: Observed Outcomes ,[object Object],[object Object],[object Object],[object Object]
Animal Studies: Problems in Interpretation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Human Data ,[object Object],[object Object],[object Object]
PEP in Humans / HCW ,[object Object],[object Object],[object Object],[object Object],[object Object]
CDC Case Control Study ,[object Object],[object Object],[object Object],[object Object],[object Object]
Risk Factors For HIV Transmission CDC Case Control Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Limitations of CDC Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PEP in Humans ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other Perinatal Transmission Prophylaxis Data ,[object Object],26.1 342 NO THERAPY 18.4 38 AFTER 48 hours POST-PARTUM 9.3 86 BEFORE 48 hours POST-PARTUM 10.0 50 INTRAPARTUM 6.1 423 PRENATAL Percent HIV-Infected Number Born Timing of Prophylaxis Initiation
Other Perinatal Transmission Prophylaxis Data ,[object Object],[object Object],[object Object],[object Object]
GUIDELINES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Guidelines: The Goal ,[object Object]
Indications for PEP NYSDOH CDC ,[object Object],[object Object],Recommendations are the same
Immediate Measures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Antiretroviral Regimens NYSDOH CDC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Combivir) (Combivir)
Alternative Regimens ,[object Object],[object Object],[object Object],[object Object],[object Object]
Initiation of PEP NYSDOH vs. CDC ,[object Object],[object Object],[object Object],[object Object]
Duration of Therapy ,[object Object],[object Object]
NYSDOH vs. CDC
ZDV PEP Treatment Failures in HCWs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Implementation of PEP Programs
Designing a PEP Program ,[object Object],[object Object],[object Object],[object Object]
Institutional Procedures ,[object Object],[object Object],[object Object],[object Object]
Institutional Procedures: Counseling ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Institutional Procedures: Counseling ,[object Object],[object Object],[object Object]
Procedures: Access to Therapy ,[object Object],[object Object],[object Object],[object Object]
Occupational Exposure & PEP: The Central Issues ,[object Object],[object Object]
Reality of PEP ,[object Object],[object Object],[object Object],[object Object]
Acknowledgments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Recommendations Hepatitis B ,[object Object],[object Object],[object Object]
Recommendations Hepatitis C ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Management of HIV - Post-Exposure Prophylaxis Management of HIV - Post-Exposure Prophylaxis

  • 1. Occupational Exposure Management of HIV Post-Exposure Prophylaxis Bruce D. Agins, MD MPH Medical Director, AIDS Institute New York State Department of Health
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