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Epidemiologic studies show that needle sticks occur commonly among health care professionals, especially among surgeons performing invasive procedures, inexperienced hospital house staff, and medical students Efforts to reduce needle sticks should focus on avoiding recapping needles and use of safety needles whenever doing invasive procedures under controlled circumstances The risk of HIV transmission from a needle stick with blood from an HIV-infected patient is about 1:300 The risk is higher with deep punctures, large inocula, and source patients with high viral loads The risk from mucous membrane contact is too low to quantitate Health care professionals who sustain needle sticks should be counseled and offered HIV testing as soon as possible HIV testing is done to establish a negative baseline for worker s compensation claims in case there is a subsequent conversion Follow-up testing is usually performed at 6 weeks, 3 months, and 6 months A case-control study by the CDC indicates that administration of zidovudine following a needle stick decreases the rate of HIV seroconversion by 79% Therefore, providers should be offered therapy with Combivir (zidovudine 300 mg plus lamivudine 150 mg orally twice daily) Providers who have exposures to persons who are likely to have antiretroviral drug resistance (eg, persons receiving therapy who have detectable viral loads) should have their therapy individualized, using at least two drugs to which the source is unlikely to be resistant Some clinicians recommend triple combination regimens, including a protease inhibitor for all occupational

A multicenter trial showed that when zidovudine is administered to women during pregnancy, labor, and delivery and to their newborns, the rate of HIV transmission is decreased by two-thirds An observational trial demonstrated that zidovudine treatment is almost as effective when begun during labor or when administered only to the infant, as long as treatment is begun within 48 hours after birth Nonetheless, treatment begun by at least the second trimester is still recommended Many women are currently being offered combination antiretroviral treatment to further lower the risk of transmission The availability of treatment makes it essential that all women who are pregnant or considering pregnancy be offered HIV counseling and testing Many obstetricians recommend combination antiretroviral treatment, especially if zidovudine resistance is suspected HIV-infected women receiving antiretroviral therapy in whom pregnancy is recognized during the first trimester should be counseled about the benefits and potential risks to the fetus of treatment during the first trimester Because healthy mothers make healthy babies, continuation of therapy should be strongly considered Because about half of fetal infections in non breast-feeding women

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occur shortly before or during the birth process, antiretroviral therapy should be administered whenever a woman initiates perinatal care even if she did not begin therapy in the second trimester Breast-feeding is thought to increase the rate of transmission by 10 20% and should be avoided

Branson BM et al; Centers for Disease Control and Prevention (CDC) Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings MMWR Recomm Rep 2006 Sep 22;55(RR-14):1 17 [PMID: 16988643] Chiao EY et al Screening HIV-infected individuals for anal cancer precursor lesions: a systematic review Clin Infect Dis 2006 Jul 15;43(2):223 33 [PMID: 16779751] Johnson BT et al Sexual risk reduction for persons living with HIV: research synthesis of randomized controlled trials, 1993 to 2004 J Acquir Immune Defic Syndr 2006 Apr 15;41(5): 642 50 [PMID: 16652039] Roland ME et al Seroconversion following nonoccupational postexposure prophylaxis against HIV Clin Infect Dis 2005 Nov 15;41(10):1507 13 [PMID: 16231265] Smith DK Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the US Department of Health and Human Services MMWR Recomm Rep 2005 Jan 21;54(RR-2):1 20 [PMID: 15660015]

Treatment for HIV infection can be divided into four categories: therapy for opportunistic infections and malignancies, antiretroviral treatment, hematopoietic stimulating factors, and prophylaxis of opportunistic infections Experimental treatment regimens for HIV infection are constantly changing Clinicians may obtain up-to-date information on experimental treatments by calling the AIDS Clinical Trials Information Service (ACTIS), 800-TRIALS-A (English and Spanish), and the National AIDS Hot Line, 800342-AIDS (English), 800-344-SIDA (Spanish), and 800AIDS-TTY (hearing-impaired)

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