Expert: Terry B - 1/12/2009

Question
I am a firefighter and recently worked a wreck scene where I was splattered in the eyes with the patient's blood. Turns out the patient was not HIV positive but these results were not given to me for two and a half to three hours. What is the time frame I am dealing with, when an exposure, like blood in the eyes, occurs and the time to take the AIDS Cocktail to kill the virus and prevent me from getting AIDS? Thank you for all your help!!

Answer
Dear Brian:

Peace and all good things, thank you for your service.  The recommendations for health care workers (HCW) and post-exposure prophylaxis (PEP) are contained at

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm

and go into some great depth of analysis; bottom line is that the sooner the better.  

PEP was being practiced even prior to 1985 and a study dated from 1991-1996 is also at the Centers for Disease Control and Prevention (www.cdc.gov) website.  

I will add a few observations and opinions from my own experience:

1) While it is difficult to get clinicians and policy-makers to agree, there should be a PEP policy and it should be known, with the medications - representing the latest recommendations - available immediately to the health care worker upon informed consent.  
2) The effectiveness of PEP in killing the virus and preventing one from contracting HIV is not 100% - nor are the chances of an exposure becoming an infection 100% - the fact that there appears to be some correlation between lower rate of infection and use of the medications is sufficient to offer an exposed HCW the regimen.
3) The side-effects of the "cocktail" are significant.  In the 1991-1996 study, only 43% of those receiving PEP continued the regimen as prescribed.

Barrier protection and standard/universal precautions are the most effective way to prevent infection.  I am speaking as a former clinician trained in the days when recapping needles was the norm, and survivor of one deep needle-stick injury and multiple exposures to blood as a Navy Corpsman.  Develop habits that include standard/universal precautions and use them with all patients.

I hope this helps, please do look at the CDC guidelines - and talk to your supervisors about having a PEP kit in place for the next time this happens.

Best to you and yours,

Terry