A 28-year-old nurse comes to the occupational health clinic 30 minutes after an accidental needle stick following a blood draw from a patient who is HIV positive. The patient is on antiretroviral therapy for a drug-sensitive virus, has an undetectable viral load, and has no history of viral hepatitis. The nurse has no chronic medical issues and takes no medications. Her immunizations, including hepatitis B, are up-to-date. Laboratory results are as follows: Which of the following is most appropriate next step in management of this nurse?

Question

A 28-year-old nurse comes to the occupational health clinic 30 minutes after an accidental needle stick following a blood draw from a patient who is HIV positive.  The patient is on antiretroviral therapy for a drug-sensitive virus, has an undetectable viral load, and has no history of viral hepatitis.  The nurse has no chronic medical issues and takes no medications.  Her immunizations, including hepatitis B, are up-to-date.  Laboratory results are as follows:  Which of the following is most appropriate next step in management of this nurse?

Quizplus · Accepted Answer

Explanation: Health care personnel (HCP) are at risk for occupational acquisition of HIV infection if body fluids from a patient with HIV penetrate the cutaneous barrier (percutaneous injury, nonintact skin) or mucous membranes. Although overall transmission risk is quite low, the likelihood of infection is increased when the source patient has a high viral load or the exposure is large/deep. Cutaneous wounds should be thoroughly washed with soap and water, and exposed mucous membranes require irrigation. Laboratory testing and initiation of postexposure prophylaxis with combination antiretroviral therapy should begin 1-2 hours after exposure and continue for 4 weeks. Fourth-generation HIV testing should then be repeated at 6 weeks and 4 months to evaluate for seroconversion. HCP are also at risk of exposure to hepatitis B and hepatitis C, which are far more transmissible than HIV. (Choices A and B) Although the overall risk of HIV transmission is low (particularly in this case due to an undetectable viral load in the source patient), infections are potentially devastating. Exposed HCP require prompt intervention with postexposure prophylaxis to reduce the risk of transmission. (Choice C) Viral load is unlikely to be elevated immediately after potential inoculation. (Choice D) Although monotherapy prophylaxis (eg, zidovudine) has been used with some efficacy, 3-drug therapy is considered superior and is the current standard of care. Educational objective: Postexposure prophylaxis with combination antiretroviral treatment is recommended for all health care personnel who have percutaneous or mucous membrane exposure to HIV-infected bodily fluids.

A 28-Year-Old Nurse Comes to the Occupational Health Clinic 30