HIV Post-Exposure Prophylaxis (PEP) is a short-term antiretroviral treatment administered to reduce the risk of HIV infection following potential occupational exposure in healthcare settings. In Ghana, prompt initiation within 1-2 hours (and no later than 72 hours) post-exposure is crucial for effectiveness, particularly for healthcare personnel at risk from needle-stick injuries or mucous membrane contact.
🦠 Overview and Pathophysiology
PEP prevents HIV establishment after exposure to infected blood or body fluids:
Causes of Exposure
- Percutaneous: Needle-stick or cut with sharp object
- Mucocutaneous: Contact with mucous membranes or non-intact skin
- Risk Factors: Large volume of blood, advanced HIV in source, deep injury
Risk Levels
- Very Low: Intact skin exposure
- Low: Small volume from asymptomatic patient, superficial injury
- High: Large volume, high viral load source, hollow bore needle
- Key Point: Risk ~0.3% for percutaneous, lower for mucous
🔍 Risk Assessment
Immediate evaluation post-exposure is essential:
Steps to Prevent Transmission
Wound Care: Clean with soap and water
Mucous Membranes: Flush with water or saline
Assess Risk: Classify as very low, low, or high based on exposure type and source
- Report to supervisor and document exposure
- Counsel and test exposed worker and source patient
- Initiate PEP within 1-2 hours if indicated
🧪 Investigations
Baseline and follow-up tests to monitor sero-status and toxicity:
| Time Point | Tests |
|---|---|
| Baseline | Full blood count, Liver and renal function tests, Hepatitis B Surface Antigen, HIV serology or PCR |
| Two weeks | Full blood count, Liver and renal function tests |
| Six weeks | HIV serology |
| Three months | HIV serology |
| Six months | HIV serology |
💊 Treatment
Objectives: Prevent HIV infection establishment. Timing: Initiate promptly, preferably within 1-2 hours, not beyond 72 hours.
Non-Pharmacological
Counselling: Immediate and ongoing; emphasize safe sex and condom use
Source Testing: Counsel and test source patient if status unknown
Documentation: Record exposure details, management, and follow-ups
Very Low Risk
- Treatment: Wash exposed area with soap and water
- Evidence: [A]
Low Risk
- Preferred: Tenofovir 300 mg daily + Emtricitabine 200 mg daily for 28 days
- Alternative: Zidovudine 300 mg 12 hourly + Lamivudine 150 mg 12 hourly for 28 days
High Risk
- Preferred: Tenofovir 300 mg daily + Emtricitabine 200 mg daily + Lopinavir/r 400/100 mg 12 hourly for 28 days
- Alternative: Zidovudine 300 mg 12 hourly + Lamivudine 150 mg 12 hourly + Lopinavir/r 400/100 mg 12 hourly for 28 days
- If source is HIV/HBV co-infected, use Tenofovir-containing regimen
- Monitor for drug toxicity and HIV sero-conversion
- Refusal of testing should be documented
📝 Reporting and Documentation
All exposures must be reported and documented:
Required Details
Incident: Date, time, location, how it occurred, exposure site, device type
Exposure: Type and amount of fluid, severity
Source: Status, clinical details
Exposed Worker: Medical conditions, vaccinations (e.g., Hepatitis B), medications, pregnancy/breast-feeding
🚨 Referral Criteria
- Sero-conversion or positive HIV test post-exposure
- Adverse drug reactions or complications
- Access to comprehensive care and ART services
Refer to accredited treatment centres in Ghana.
🧠 Key Takeaways
- ✅ Act Fast: Initiate PEP within 1-2 hours, max 72 hours
- ✅ Risk Stratify: Very low (wash only), low/high (ART regimens)
- ✅ Counsel & Test: Exposed worker and source; ongoing support
- ✅ Monitor: Baseline/follow-up tests for toxicity and sero-status
- ✅ Document: All details for reporting and follow-up
- ✅ Special: Tenofovir for HBV co-infection