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Provisional Public Health Service Recommendations for Chemoprophylaxis after Occupational Exposure to HIV by Type of Exposure and Source Material -- 1996
Type of exposure	Source material*	Antiretroviral prophylaxis?	Antiretroviral regimen?
Percutaneous	Blood¶  Highest risk  Increased risk  No increased risk  Fluid containing visible blood, other potentially infectious fluid??, or tissue  Other body fluid (e.g., urine)	Recommended Recommended Offer  Offer         Not offer	ADV plus 3TC plus IDV AVD plus 3TC, ± IDV** ZDV plus 3TC  ZDV plus 3TC
Mucous membrane	Blood  Fluid containing visible blood, other potentially infectious fluidÝÝ, or tissue Other body fluid (e.g., urine)	Offer  Offer  Not offer	ZDV plus 3TC, ±IDV**  ZDV, ±3TC
Skin, increased risk**	Blood Fluid containing visible blood, other potentially infectious fluid??, or tissue Other body fluid (e.g., urine)	Offer Offer Not offer	ZDV plus 3TC, ±IDV** ZDV, "3T

* Any exposure to concentrated HIV (e.g., in a research laboratory or production facility) is treated as percutaneous exposure to blood with highest risk. 

Ý Recommend-Postexposure prophylaxis (PEP) should be recommended to the exposed worker with counseling (see text). Offer-PEP should be offered to the exposed worker with counseling (see text). Not offer-PEP should not be offered because these are not occupational exposures to HIV. 

* Regimens: zidovudine (ZDV), 200 mg three times a day; lamivudine (3TC), 150 mg two times a day; indinavir (IDV), 800 mg three times a day (if IDV is not available, saquinavir may be used, 600 mg three times a day). Prophylaxis is given for 4 weeks. For full prescribing information, see package inserts. 

¶ Highest risk-BOTH larger volume of blood (e.g., deep injury with large diameter hollow needle previously in source patient?s vein or artery, especially involving an injection of source-patient?s blood) AND blood containing a high titer of HIV (e.g., source with acute retroviral illness or end-stage AIDS; viral load measurement may be considered, but its use in relation to PEP has not been evaluated). Increased risk- EITHER exposure to larger volume of blood OR blood with a high titer of HIV. No increased risk -NEITHER exposure to larger volume of blood NOR blood with a high titer of HIV (e.g., solid suture needle injury from source patient with asymptomatic HIV infection). 

** Possible toxicity of additional drug may not be warranted (see text). 

ÝÝ Includes semen; vaginal secretions; cerbrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids. 

¶ ¶ For skin, risk is increased for exposures involving a high titer of HIV, prolonged contact, an extensive area, or an area in which skin integrity is visibly compromised. For skin exposures without increased risk, the risk for drug toxicity outweighs the benefit of PEP. 

Table reprinted from Update:
Provisional Public Health Service Recommendations for Chemoprophylaxis After Occupational Exposure to HIV, MMWR 45(22), 1996.