Recommendations for adult and pediatric prophylaxis following exposure to the human immunodeficiency virus and hepatitis B and C viruses

The aim of this review facilitate the appropriate use of prophylaxis after occupational or nonoccupational exposure to the human immunodeficiency virus (HIV) or hepatitis B or C viruses (HBV and HBC). The recommendations are the result of consensus among expert panelists brought together by the office of the Spanish national secretariat for AIDS (SPNS) and a group of scientific societies. The panel reviewed the most important current epidemiologic and clinical studies in the literature or presented at scientific conferences and seminars. The risk of HBV, HCV, and HIV transmission after occupational exposure depends on the type of exposure, the serological status of the worker, the virologic status of the source, and the time elapsed after the accident. Prophylaxis following exposure is always recommended in cases of high or very high risk, and it is offered as an option in other cases. Ideally, prophylaxis should be initiated within 6 hours of exposure and certainly within 72 hours. Three antiretroviral drugs are generally prescribed except in situations of very low risk, when the use of 2 drugs might be acceptable. Treatment should be continued for at least 24 weeks. In nonoccupational exposure, the level of risk should be assessed thoroughly and the appropriate prophylactic measure taken. Prophylaxis should always be recommended after high-risk exposures and should be considered whenever there is appreciable risk. Once it has been determined that the exposure was exceptional, the physician and patient should come to an agreement regarding prophylaxis. The antiretroviral treatment protocols are the same after occupational and nonoccupational exposures. It is very important for health care facilities that dispense antiretroviral drugs to have risk assessment tools and action protocols at their disposal. [Emergencias 2009;21:42-52]