HIV PEP rarely warranted after mass casualties
CDC guidelines for HIV, hepatitis and tetanus
The Centers for Disease Control and Prevention has issued recommendations for postexposure interventions to prevent infection with HIV and other bloodborne pathogens among the wounded during mass casualty events. For HIV, there is generally no need for action, though PEP (post-exposure prophylaxis) may be considered for "extraordinary" situations. For example, in settings in which exposure to an HIV-infected source is known or thought to be highly likely (e.g., a blast injury incident that occurred in a research facility that contained a large archive of HIV infected blood specimens), the CDC noted.
Both victims and responders may be exposed to blood, body fluids, or tissue from other injured persons and thus be at risk for bloodborne infections. When evaluating management choices for casualties of bombings or other mass-casualty events, health-care providers should assume that exposure to blood from other injured persons is likely unless available information on the circumstances of injury suggests otherwise. Blast injuries result occasionally in traumatic implantation of bone or other biologic material that is alien to the wounded person.
In the rare event that HIV PEP is considered, it should be initiated as soon as possible after exposure. The patient should be counseled about the availability of PEP and informed about the potential benefits and risks and the need for prompt initiation to maximize potential effectiveness. If PEP is thought to be indicated on the basis of exposure risk, administration should not be delayed for HIV test results. In the rare event that HIV PEP is administered, specimens should be collected for baseline HIV testing on all patients provided with PEP using a blood or oral fluid rapid test if available; otherwise, conventional testing should be used. Testing should be discussed with the patient if the patient's medical condition permits. Procedures for testing should be in accordance with applicable state and local laws. PEP can be initiated and test results reviewed at follow-up. If the HIV test result is positive, PEP can be discontinued and the patient referred to a clinician experienced with HIV care for treatment.
If PEP is administered, the health-care provider also should obtain baseline complete blood count, renal function, hepatic function tests, and, in women, a pregnancy test. Because efavireniz might be teratogenic, it should not be administered until pregnancy test results are available. Otherwise, test results need not be available before PEP initiation but should be reviewed in follow-up. Selection of antiretroviral regimens should aim for simplicity and tolerability. Because of the complexity of selection of HIV PEP regimens, consultation with persons having expertise in antiretroviral therapy and HIV transmission is strongly recommended
Reference
- Centers for Disease control and Prevention Recommendations for Postexposure Interventions to Prevent Infection with Hepatitis B Virus, Hepatitis C Virus, or Human Immunodeficiency Virus, and Tetanus in Persons Wounded During Bombings and Other Mass-Casualty Events --- United States, 2008. MMWR 2008; 57(RR06):1-19.
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