42. A 24-year-old health-care worker sustain - highsky

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42. A 24-year-old health-care worker sustains a significant deep percutaneous injury while drawing blood from an HIV-positive patient, with a hollow bore needle. The patient™s CD4 count is 90/miro-L and his viral load is 300,000 copies/mL. His medication includes zidovudine, lamivudine, indinavir and trimethoprim-sulfamethoxazole. The health-care worker is extremely anxious about the further plans. What will be the most appropriate next step in the management of his HIV exposure?

A. Reassurance
B. Draw his blood for HIV serology and start single drug antiretroviral therapy if serology is positive
C. Draw his blood for HIV serology and start antiretroviral therapy with three drugs if serology is positive
D. Draw his blood for HIV serology and start single drug antiretroviral therapy while awaiting the results for HIV serology
E. Draw his blood for HIV serology and start antiretroviral therapy with three drugs while awaiting the results for HIV serology

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Whenever a health-care worker is exposed to the blood or blood products of HIV infected patients, testing for HIV should be performed immediately as baseline studies and should be repeated at 6 weeks, 3 months and 6 months. HIV postexposure prophylaxis should be started without delay once the blood is drawn for baseline serological studies. Postexposure prophylaxis is done with the combination of two or three drugs. Two nucleoside reverse transcriptase inhibitors are used for this purpose and a third drug if used, is a protease inhibitor. Addition of the third drug adds more efficacy to the two-drug regimen and may be routinely used in all patients. The addition of third drug is particularly indicated for exposures that pose an increased risk (very low CD4 count, high viral load and the type of injury i.e. deep percutaneous injury with a hollow bore needle) for transmission. Reassurance and waiting for the results of serology may result in unnecessary delay and are not appropriate choices.
Educational Objective:
Whenever a health care worker is exposed to HIV, baseline HIV testing should be performed immediately and postexposure prophylaxis with combination of two or three antiretroviral drugs should be started without any delay.

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