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Occupational Postexposure ProphylaxisQuestion 6/10

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At approximately 11:30 p.m., a 32-year-old neurosurgery resident suffered a scalpel cut on the tip of his left fifth finger during an emergency brain surgery involving a patient with HIV. The scalpel had visible blood on it prior to the surgeon suffering the cut. The scalpel injury occurred about 30 minutes into a complex surgery estimated to last 4 to 5 hours total. The source patient is taking rilpivirine-tenofovir alafenamide-emtricitabine, but recent results for an HIV RNA level are not available. The surgeon scrubs out of the case and thoroughly washes the scalpel injury wound with soap and water. The scalpel cut on the finger is shallow but approximately 0.5 cm long; initial bleeding is stopped after pressure is applied to the wound. 

What is the best next action regarding HIV occupational postexposure prophylaxis (PEP) for this surgeon?

Abbreviations: SIV = simian immunodeficiency virus; PEP = postexposure prophylaxis; TFV = tenofovir<br /> In this study, investigators inoculated 24 macaques intravenously with very high-titer simian immunodeficiency virus (SIV). Four animals received placebo postexposure prophylaxis. The remaining 20 animals received postexposure prophylaxis with subcutaneous tenofovir (TFV), beginning at either 24, 48, or 72 hours after the exposure; the duration of the tenofovir was either 3, 10, or 28 days. Note that tenofovir is (R)-9-(2-phosphonylmethoxypropyl) adenine [PMPA].
Figure 1 (Image Series). Effectiveness of Tenofovir Postexposure Prophylaxis in Macaques
Abbreviations: SIV = simian immunodeficiency virus; PEP = postexposure prophylaxis; TFV = tenofovir
In this study, investigators inoculated 24 macaques intravenously with very high-titer simian immunodeficiency virus (SIV). Four animals received placebo postexposure prophylaxis. The remaining 20 animals received postexposure prophylaxis with subcutaneous tenofovir (TFV), beginning at either 24, 48, or 72 hours after the exposure; the duration of the tenofovir was either 3, 10, or 28 days. Note that tenofovir is (R)-9-(2-phosphonylmethoxypropyl) adenine [PMPA].
Source: Tsai CC, Emau P, Follis KE, et al. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol. 1998;72:4265-73.
Abbreviations: SIV = simian immunodeficiency virus<br /> As shown in this graphic, all 4 placebo-treated macaques became infected with SIV. The best outcome occurred with the animals that started tenofovir at 24 hours and received a total of 28 days of therapy.
Figure 1B. Study Results
Abbreviations: SIV = simian immunodeficiency virus
As shown in this graphic, all 4 placebo-treated macaques became infected with SIV. The best outcome occurred with the animals that started tenofovir at 24 hours and received a total of 28 days of therapy.
Source: Tsai CC, Emau P, Follis KE, et al. Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl) adenine treatment for prevention of persistent simian immunodeficiency virus SIVmne infection depends critically on timing of initiation and duration of treatment. J Virol. 1998;72:4265-73.
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Question Last Updated
September 20th, 2023

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