Page 123 - PJ MED OPS Handbook 8th Ed

HIV Post Exposure Prophylaxis (PEP)

SPECIAL CONSIDERATIONS:
1. Initiation of the highly active antiretroviral therapy (HAART) should ideally occur within
2 hours of exposure, but still has some effect up to 72 hours after exposure.
2. Antiretrovirals have a significant side-effect profile, including nausea, vomiting, diarrhea.
3. Obtain a sample of the source’s blood for HIV and hepatitis testing, if possible.
4. Use of a commercially available Rapid HIV Test Kit that uses either an oral specimen or
whole blood is recommended for source testing within 1–2 hours to determine if HAART
therapy should be initiated.

PJ PEARL: These meds are not in the Pararescue Formulary; however, accidental needle sticks
or punctures by sharp bone shards from patients with traumatic amputations have occurred.
PJs were subsequently placed on prophylactic therapy. It is important to be aware of this risk
and ensure treatment is available. Many deployments are to regions with high rates of HIV.

High Risk Exposures:
1. Percutaneous injury (needle stick or other contaminated penetrating injury).
2. Exposure or exchange of body fluids with persons at high risk for HIV.
3. Transfusion of blood products that have not undergone standard U.S. blood bank or equivalent
testing for transmissible diseases.
4. When attempting to evaluate a high-risk exposure, take into account the source of the bodily
contamination, ex: blood from an American military member would generally fall into low risk.
Management:
1. Wash area with soap and water to clean area and minimize exposure.
2. Use a Rapid HIV Test Kit to determine if therapy should be initiated.

WARNING In high risk situations, do not delay initiation of therapy if the test kit is not available.
HIV PEP should be started within 1–2 hours of exposure.

3. Consult with unit medical officer ASAP to discuss the case and obtain further guidance after any
significant exposure.
a. If the Rapid HIV Test is positive, initiate PEP.
b. If high-risk exposure occurs and a Rapid HIV Test is unavailable, initiate PEP.
c. If a Rapid HIV Test is neg, seek medical officer guidance to determine the need for PEP.
4. Initiate antiretroviral triple therapy according to medical oversight.
5. Do not use alcoholic beverages after Combivir administration.
6. For GI side-effects of medication, treat per Nausea and Vomiting Protocol.
7. Maintain hydration and nutrition status.

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 121