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1. Massive percutaneous exposure (e.g., deep injury with large-bore needle previously in source patient's vein or artery); exposure to smaller amount of blood with high HIV titre; mucous membrane or high-risk skin exposure (high HIV titre in source patient; prolonged contact; extensive area involved; skin integrity compromised).

Recommend

zidovudine 200 mg, tid x 4 weeks $35.70/week

AND

lamivudine 150 mg, bid x 4 weeks $61.60/week

AND, possibly

indinavir 800 mg, tid x 4 weeks $112.98/week

2. Massive percutaneous exposure to blood with high HIV titre.

Recommend

zidovudine 200 mg, tid x 4 weeks $35.70/week

AND

lamivudine 150 mg, bid x 4 weeks $61.60/week

AND

indinavir 800 mg, tid x 4 weeks $112.98/week

3. Percutaneous exposure to smaller amount of blood with low titre, to fluid containing visible blood or to other potentially infectious fluid (semen or vaginal, cerebrospinal, synovial, pleural, peritoneal, pericardial or amniotic fluid) or tissue.

Offer

zidovudine 200 mg, tid x 4 weeks $35.70/week

AND

lamivudine 150 mg, bid x 4 weeks $61.60/week

4. Mucous membrane or high-risk skin exposure to fluid containing visible blood or other potentially infectious fluid or tissue.

Offer

zidovudine 200 mg, tid x 4 weeks $35.70/week

AND, possibly

lamivudine 150 mg, bid x 4 weeks $61.60/week

5. Percutaneous, mucous membrane or skin exposure to other body fluid (e.g., urine)

Do not offer prophylaxis.

-The average risk of acquiring HIV infection after percutaneous exposure to HIV-infected blood is only 0.3%. Postexposure prophylaxis with zidovudine can reduce this risk by as much as 79%.

-Prophylaxis should be started within 1 to 2 h after exposure and no longer than 24 h after exposure.

-The extrapolation of guidelines for postexposure prophylaxis to other situations, such as sexual assault, is unclear at this time.

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