OCCUPATIONAL EXPOSURE TO HIV: INFORMATION SHEET …



Occupational exposure to HIV: Information sheet regarding HIV post exposure prophylaxis (PEP)

The following information is to help you if you have been recommended to take HIV PEP

What is HIV prophylaxis?

PEP is a combination of three drugs taken after a potentially serious exposure to HIV for 28 days1 .If you have been exposed to HIV it can take 3 days to travel to your lymph nodes (glands). Once in the glands the infection will stay in your body for the rest of your life (HIV positive). If you take PEP soon after you have been exposed you may be able to prevent HIV from getting into the lymph nodes and you may remain HIV negative.

You should start the treatment as soon as you can, ideally within 24 hours of exposure, but you have up to 72 hours after the exposure to take the first dose.

These drugs are known as anti-HIV are used to treat HIV infection and have been shown to be very effective in reducing HIV levels in the blood.

Why is prophylaxis recommended?

A study of HIV infection in healthcare workers following needle-stick injuries has shown that treatment with one drug called Zidovudine (AZT) showed a 79% reduction becoming HIV positive. In the light of this study the Department of Health has issued guidelines on the use of post-exposure prophylaxis (PEP) for healthcare workers potentially exposed to HIV.

The Department of Health also collects and publishes data on Occupational exposure to blood borne viruses (Eye of the Needle 20142). In 2014 598 occupational exposures to known HIV were reported. Of the 580 that took PEP none developed HIV.

What is the risk of HIV being transmitted following an exposure?

The risk of acquiring HIV from an HIV positive person not on treatment following a needle-stick injury is only 1 in 333. This risk is much lower than an exposure to Hepatitis B (1 in 3) or Hepatitis C (1 in 30) and so it is not always necessary to take PEP. The risk is higher if the injury you have is deep and / or contains the patient’s blood. PEP is also recommended if you have been exposed to high risk body fluids or tissues know to be, or strongly suspected to be, infected with HIV such as pleural fluid, amniotic fluid and breast milk. Saliva, urine, tears, nasal secretions and sweat and faeces are low risk for HIV.

What is the prophylaxis medication?

Truvada and Raltegravir are currently recommended as first line treatment for PEP and PEPSE3,4. Raltegravir is the most effective drug in reducing HIV virus levels over 4 weeks compared to other anti-HIV treatments and this is why it is used after a potential exposure to HIV.

|NAME |Dose |Frequency |Total duration |

|Truvada® |One tablet |Once a day |28 days |

|(Tenofovir 245 mg / |(blue) | | |

|Emtricitabine 200 mg) | |With food to increase absorption | |

|Isentress® |One tablet |Twice a day |28 days |

|Raltegravir 400mg |(pink) |Every 12 hours | |

| | |With or without food but Do not break or crush | |

You will have been given a PEP starter pack with the first 3-7 days of treatment. You will need to attend the Rubin Clinic, Department of Sexual health, 1st Floor, Green Zone, Maidstone Hospital for the rest of the treatment. It is very important that you attend the clinic as soon as you can to avoid running out of the treatment as it is important not to miss any of the tablets. The clinic is open Monday to Friday each week. You can walk in every morning between 9am and 11am except Wednesday and let reception staff know that you are on PEP. If you prefer an appointment you must call 01622 225713 to arrange this

You will need to take the tablets every day for 28 days. It is very important to take them each day. It is best to take them at the same time every day and to set an alarm to remind you especially if you do not usually take medication. You should not miss any doses of the tablets. Missing doses may increase the chance that treatment does not work.

Follow-up

You will be required to attend the Sexual health clinic once after you begin your starter pack of PEP and again at the end of treatment. When you start treatment you will be asked to have some blood and urine tests to check your liver and kidney function. If any of these tests are abnormal we may need to see you once in the middle of treatment as well.

You will need to have a blood test for HIV after you have finished taking your treatment. You should arrange to have an HIV test at 4 and 8 weeks (5) after the exposure event and this can be arranged with the Sexual health clinic or your Occupational Health clinic.

What are the possible side effects of the medicines?

Like all medicines, Truvada and Raltegravir may cause side effects, although not everybody gets them. If you do develop side effects they are most likely to be mild and short term. There are more details on the side effects of Truvada and Raltegravir in the patient information leaflets enclosed.

Commonly reported side-effects of these medicines that may affect up to 10% people (that is up to 10 in every 100 people) includes:

• nausea (feeling sick)

• diarrhoea

• headache

• lack of energy or weakness

• loss of appetite

• stomach ache

• dizziness

• trouble sleeping

• rash

Many of these side effects can be managed. Some people can feel nauseous or vomit in the first few days so you will have been given an anti-sickness pill called Domperidone to help with this. Take this regularly for the first week and then as and when required after this as this side effect usually improves after this time.

|NAME |Dose |Frequency |Total duration |

|Domperidone 10mg |One tablet |Three times a day |As required |

| | |Every 8 hours | |

Other common side effects are headache and diarrhoea and you can take Paracetamol and Loperamide (Imodium) if this occurs.

If you develop a rash or flu-like illness whilst taking this medicine, or during the 12 weeks after finishing treatment, it is important you contact your clinic immediately to discuss your symptoms to ensure they are not an allergic reaction or signs of HIV infections.

If you experience any of these side effects or any other problems which are distressing and cannot be tolerated, or you feel you cannot continue to take your tablets please return to the clinic to seek expert advice or to discuss a suitable alternative. Do not stop treatment without seeking medical advice.

Can I take other medicines?

You should tell the doctor if you are taking any other medication and check that any new medication you are given does not interact with this treatment. Drug interactions can be checked on hiv- or with the HIV specialist pharmacist on bleep 1480.

|INTERACTIONS |See interaction charts at hiv- |

|Aluminium and magnesium containing antacids|Reduced levels of raltegravir – stop antacid and prescribe PPI/H2 antagonist |

|Calcium supplements |Raltegravir levels may be reduced – separate administration i.e. 4 hours after or 6 hours before |

|Iron supplements |Raltegravir levels may be reduced – separate administration i.e. 4 hours after or 6 hours before |

|Multivitamins |Raltegravir levels may be reduced – separate administration i.e. 4 hours after or 6 hours before |

|Rifampicin |Raltegravir levels may be reduced – separate administration – avoid if possible or consider double dose|

| |of raletgravir 800mg twice a day. |

|Antidepressants (including St Johns Wort) |Interactions unlikely to be significant |

|Antipsychotics / Neuroleptics |Interactions unlikely to be significant |

|Methandone |Interactions unlikely to be significant |

|Combined and Progesterone hormonal |Interactions unlikely to be significant |

|contraception | |

|Orlistat |Interaction possible with raltegravir – monitor raltegravir levels |

|Nephrotoxic drugs e.g. Aminoglycosides. |May increase nephrotoxicity caused by Tenofovir or Emtricitabine (Truvada) |

|Foscarnet, amphotericn B, ganciclovir, | |

|vancomycin | |

What should I do if I forgot to take any tablets?

Anti-HIV medicines work best if there is a constant amount of the drugs in your body. It is important that you take them regularly and as prescribed.

If you forgot to take the Truvada or Raltegravir please follow the advice below:

• If < 24 hours has elapsed since the last dose take the missed dose as quickly as possible and continue your doses at usual time.

• If 24 to 48 hours have elapsed since last dose continue with PEP at usual time

• If > 48 hours have elapsed since last dose stop PEP.

Remember that missing doses may increase the chance that the treatment doesn’t work, so try not to forget to take your medicines.

Other information

While you are being treated and until you have received the results of the HIV test, you should use condoms at all times with any sexual partners. You should not donate blood during this time and avoid sharing toothbrushes and razors.

Further information about these drugs, their side effects and interactions can be found on the following:

• electronic medicines compendium (eMC .uk)

• hiv-druginteractions.orh.uk

• Trust Medicines Information Department

• HIV pharmacist on bleep 1480

• GUM Consultants on extension 25713

References

1. Department of Health Expert Advisory Group on AIDS (2008). UK guidance on HIV Post Exposure Prophylaxis

2. British Association of Sexual Health and HIV (BASHH) UK guideline for the use of post exposure prophylaxis for HIV following sexual exposure (2015)

3. Eye of the Needle 2014 UK Kingdom Surveillance of Significant occupational exposures to bloodborne viruses in healthcare workers. PHE publications gateway number: 2014537

4. Expert Advisory Group on AIDS (EAGA) Change to recommended regimen for post exposure prophylaxis (September 2014)

5. BASHH/EAGA Position statement on HIV window period (November 2014)

Disclaimer: Printed copies of this document may not be the most recent version.

The master copy is held on Q-Pulse Document Management System

This copy – REV3.0

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download