Nonoccupational HIV postexposure prophylaxis: a new role for the emergency department.

Despite numerous primary prevention campaigns, new cases of HIV infection are occurring at high rates. Postexposure prophylaxis (PEP) after possible HIV exposures from sexual encounters or injection drug use may prove to be a worthwhile means of reducing HIV infection. Although there are no studies that directly demonstrate its efficacy, indirect support comes from animal and human studies. Multiple animal studies have shown that antiretroviral medications can reduce simian immunodeficiency virus infections if given early and for a prolonged period. A study of health care workers suggests that zidovudine taken after needlestick injuries can dramatically reduce HIV seroconversion. Zidovudine and nevirapine use recently showed great reductions in perinatal HIV transmission. Studies of dendritic and T-cell processing of simian immunodeficiency virus and HIV indicate that antiretroviral medications taken soon after a viral exposure may terminate viral replication. Regimens of 2 or 3 antiretroviral medications have been suggested as prophylactic measures after certain exposures. Even though limited experience exists with these populations, HIV PEP is most likely safe in pregnancy and for children. Emergency departments are encouraged to anticipate the probable demands for nonoccupational HIV PEP by establishing protocols for its rapid provision and ensuring proper follow-up care.

尽管开展了众多初级预防运动，艾滋病毒感染的新病例仍在以较高比率出现。在可能因性接触或注射吸毒而暴露于艾滋病毒之后进行暴露后预防（PEP），可能被证明是减少艾滋病毒感染的一种有价值的手段。虽然没有研究直接证明其功效，但动物和人体研究提供了间接支持。多项动物研究表明，如果早期且长期给予抗逆转录病毒药物，能够减少猴免疫缺陷病毒感染。一项针对医护人员的研究表明，在针刺伤后服用齐多夫定可大幅降低艾滋病毒血清转化。齐多夫定和奈韦拉平的使用近期在围产期艾滋病毒传播方面显示出大幅减少。对猴免疫缺陷病毒和艾滋病毒的树突状细胞及T细胞处理的研究表明，在病毒暴露后不久服用抗逆转录病毒药物可能终止病毒复制。有人建议在某些暴露后采用2种或3种抗逆转录病毒药物的方案作为预防措施。尽管在这些人群中的经验有限，但艾滋病毒暴露后预防在孕期和儿童中很可能是安全的。鼓励急诊科通过制定快速提供艾滋病毒非职业暴露后预防的方案并确保适当的后续护理，来预估可能的需求。