Post-exposure prophylaxis for Blood-Borne Viral (BBV) Infections

Abstract

Viral infections, such as human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV), are transmitted either sexually or through blood-borne contamination. The later causes enormous concern within health establishments and health care-workers. Post-exposure management of HIV rests on the use of triple Anti-Retroviral Therapy (ART), but special care must be taken to choose the right combination for particular circumstances, especially when the subject is pregnant or likely to get pregnant from the event. New-borns of mothers living with HIV require special attention, as maternal viral load plays a central role in their management. When viral load is not detectable, there is a good argument to avoid ART in these infants. Continued maternal ART is encouraged more so in women who intend to breastfeed. The management of exposure to Hepatitis B requires a detailed risk assessment of the source. In highrisk cases, Hep B immunoglobulin will be necessary otherwise passive immunisation with HBV vaccine will suffice. The use of anti-viral treatment for exposure to Hepatitis C remains controversial. New and potent drugs have been introduced but are quite expensive, and the cost-effectiveness of post-exposure therapy should be considered. Curative treatment now exists for HCV, and an option might be to follow exposed subjects up and give them definitive treatment if seroconversion occurs. This review discusses in details the practical steps in the management of sexual and occupational exposure to HIV and other blood-borne viruses with emphasis on preventing infections. Healthcare facilities should have tightly managed protocols for the management of exposure and the ability to start medication as early as possible when indicated.

Fatores associados à percepção do risco biológico e aos acidentes com material biológico em Agentes Comunitários de Saúde

“…Ainda a exposição a exsudato de feridas e sangue, dependendo da atividade estão previstas nas atribuições regulamentadas pela PNAB de 2017 (1) , as quais inclui a realização de curativo com técnica limpa e coberturas simples, e a aferição de glicemia capilar em casos excepcionais e sob a supervisão de profissional de nível superior. Vale lembrar que a exposição a sangue, e aos demais fluidos que potencialmente contenham sangue, possibilita a transmissão de agentes infecciosos como o vírus HIV, e os vírus das hepatites B, C e D (23) , dos quais apenas o vírus da hepatite B possui profilaxia pré-exposição.…”

“…O manuseio de lancetas ou agulhas hipodérmicas para medir a glicemia capilar, ou ainda agulhas usadas em campanhas de vacinação animal (24) , são objetos perfurocortantes com potencial risco de acidentes (13) , os quais são comprovadamente responsáveis pela soroconversão de profissionais da saúde para a HIV e Hepatites B e C (23) . Destaca-se que o manuseio e o descarte desses dispositivos requerem conhecimento, habilidade e atitudes.…”

Healthcare Professionals’ Practice of HIV Post-Exposure Prophylaxis in Clinical Settings in Karachi, Pakistan

“…HCPs may be prone to infections because of their unsafe practices; for instance, insensible handling of soiled needles, reutilization of imperfectly sterilized needles, inappropriate dumping of hazardous leftovers and overpopulation of patient care areas are all highly inappropriate practices [ 7 ]. Nevertheless, such infections are mainly preventable by adopting stringent infection control procedures, for instance, the use of safety devices, correct approaches of medical waste dumping, immunization and swiftly managing exposures with the use of PEP [ 10 ]. However, HCPs sometimes fail to follow all-inclusive safety measures and have risky practices in healthcare settings for a variety of reasons.…”

“…The appropriate use of ART as a prophylactic measure decreases the possibility of getting HIV infection by 81% following exposure [ 9 ]. PEP against HIV infection generally comprises first aid measures after exposure, counseling, risk assessment and laboratory examinations, accompanied by consent from the source and exposed people, followed by 28 days of ART and monitoring [ 10 , 11 ].…”

Development of a recombinant hepatitis B immunoglobulin derived from B cells collected from healthy individuals administered with hepatitis B virus vaccines: A feasibility study

“…It was first developed in the 1970s for passive immunization against infection by the hepatitis B virus (HBV) 1,2 . Anti‐virals, such as nucleos(t)ide analogs, are widely used as a treatment for HBV‐related diseases and as prophylactics against HBV reactivation, 3,4 while HBIG is used to prevent mother‐to‐child transmission and for post‐exposure prophylaxis 5–7 . In Japan, HBIG is also approved for use as a prophylactic agent against HBV reactivation during liver transplantations related to HBV infection, where either the recipients or donors are positive for HBV.…”