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Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis

Published online by Cambridge University Press:  02 January 2015

David T. Kuhar*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David K. Henderson
Affiliation:
Office of the Deputy Director for Clinical Care, Clinical Center, National Institutes of Health, Bethesda, Maryland
Kimberly A. Struble
Affiliation:
Division of Antiviral Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
Walid Heneine
Affiliation:
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Vasavi Thomas
Affiliation:
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Laura W. Cheever
Affiliation:
HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland
Ahmed Gomaa
Affiliation:
Division of Surveillance, Hazard Evaluation, and Health Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio
Adelisa L. Panlilio
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS A-31, Atlanta, GA 30333 (jto7@cdc.gov)

Abstract

This report updates US Public Health Service recommendations for the management of healthcare personnel (HCP) who experience occupational exposure to blood and/or other body fluids that might contain human immunodeficiency virus (HIV). Although the principles of exposure management remain unchanged, recommended HIV postexposure prophylaxis (PEP) regimens and the duration of HIV follow-up testing for exposed personnel have been updated. This report emphasizes the importance of primary prevention strategies, the prompt reporting and management of occupational exposures, adherence to recommended HIV PEP regimens when indicated for an exposure, expert consultation in management of exposures, follow-up of exposed HCP to improve adherence to PEP, and careful monitoring for adverse events related to treatment, as well as for virologie, immunologic, and serologic signs of infection. To ensure timely postexposure management and administration of HIV PEP, clinicians should consider occupational exposures as urgent medical concerns, and institutions should take steps to ensure that staff are aware of both the importance of and the institutional mechanisms available for reporting and seeking care for such exposures. The following is a summary of recommendations: (1) PEP is recommended when occupational exposures to HIV occur; (2) the HIV status of the exposure source patient should be determined, if possible, to guide need for HIV PEP; (3) PEP medication regimens should be started as soon as possible after occupational exposure to HIV, and they should be continued for a 4-week duration; (4) new recommendation—PEP medication regimens should contain 3 (or more) antiretroviral drugs (listed in Appendix A) for all occupational exposures to HIV; (5) expert consultation is recommended for any occupational exposures to HIV and at a minimum for situations described in Box 1; (6) close follow-up for exposed personnel (Box 2) should be provided that includes counseling, baseline and follow-up HIV testing, and monitoring for drug toxicity; follow-up appointments should begin within 72 hours of an HIV exposure; and (7) new recommendation—if a newer fourth-generation combination HIV p24 antigen-HIV antibody test is utilized for follow-up HIV testing of exposed HCP, HIV testing may be concluded 4 months after exposure (Box 2); if a newer testing platform is not available, follow-up HIV testing is typically concluded 6 months after an HIV exposure.

Type
Us Public Health Service Guideline
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Siegel, JD, Rhinehart, E, Jackson, M, et al.2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35(10suppl 2):S65S164.CrossRefGoogle ScholarPubMed
2.Centers for Disease Control and Prevention. Public Health Service statement on management of occupational exposure to human immunodeficiency virus, including considerations regarding zidovudine postexposure use. MMWR Recomm Rep 1990; 39(RR-1):114.Google Scholar
3.Centers for Disease Control and Prevention. Update: provisional Public Health Service recommendations for chemoprophylaxis after occupational exposure to HIV. MMWR Morb Mortal Wkly Rep 1996;45(22):468480.Google Scholar
4.Centers for Disease Control and Prevention. Public Health Service guidelines for the management of health-care worker exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 1998;47(RR-7):133.Google Scholar
5.Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001;50(RR-11):152.Google Scholar
6.Panlilio, AL, Cardo, DM, Grohskopf, LA, Heneine, W, Ross, CS; US Public Health Service. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2005;54(RR-9):117.Google Scholar
7.Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60(RR-7):145.Google Scholar
8.Smith, DK, Grohskopf, LA, Black, RJ, et al; US Department of Health and Human Services. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep 2005;54(RR-2):120.Google ScholarPubMed
9.Havens, PL; American Academy of Pediatrics Committee on Pediatric AIDS. Postexposure prophylaxis in children and adolescents for nonoccupational exposure to human immunodeficiency virus. Pediatrics 2003;111(6 pt 1):14751489.CrossRefGoogle Scholar
10.Panel on Treatment of HIV-infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States, http://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf. Published 2012. Accessed August 23, 2012.Google Scholar
11.Bell, DM. Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am J Med 1997; 102(5B):915.CrossRefGoogle ScholarPubMed
12.Centers for Disease Control and Prevention. The National Surveillance System for Healthcare Workers (NaSH): Summary Report for Blood and Body Fluid Exposure Data Collected from Participating Healthcare Facilities (June 1995 through December 2007). Washington, DC: US Department of Health and Human Services, 2011.Google Scholar
13.Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention. Healthcare Infection Control Practices Advisory Committee (HICPAC): Meeting Summary Report, November 3-4, 2011, Washington, DC. http://www.cdc.gov/maso/FACM/pdfs/HICPAC/2011110304_HICPAC_MINUTES.pdf. Washington, DC: US Department of Health and Human Services, 2011. Accessed March 2013.Google Scholar
14.Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention. Healthcare Infection Control Practices Advisory Committee (HICPAC): Meeting Summary Report, June 14-15, 2012, Atlanta, GA. http://www.cdc.gov/maso/FACM/pdfs/HICPAC/2012061415_HICPAC_MINUTES.pdf. Washington, DC: Department of Health and Human Services, 2012. Accessed March 2013.Google Scholar
15.Wahn, V, Kramer, HH, Voit, T, Brüster, HT, Scrampical, B, Scheid, A. Horizontal transmission of HIV infection between two siblings. Lancet 1986;2(8508):694.CrossRefGoogle ScholarPubMed
16.Transmission of HIV by human bite. Lancet 1987;2(8557):522.Google Scholar
17.Richman, KM, Rickman, LS. The potential for transmission of human immunodeficiency virus through human bites. J Acquir Immune Defic Syndr 1993;6(4):402406.Google ScholarPubMed
18.Vidmar, L, Poljak, M, Tomazic, J, Seme, K, Klavs, I. Transmission of HIV-1 by human bite. Lancet 1996;347(9017):1762.CrossRefGoogle ScholarPubMed
19.Deshpande, AK, Jadhav, SK, Bandivdekar, AH. Possible transmission of HIV infection due to human bite. AIDS Res Ther 2011;8:16.CrossRefGoogle ScholarPubMed
20.Andreo, SM, Barra, LA, Costa, LJ, Sucupira, MC, Souza, IE, Diaz, RS. HIV type 1 transmission by human bite. AIDS Res Hum Retroviruses 2004;20(4):349350.CrossRefGoogle ScholarPubMed
21.Ippolito, G, Puro, V, De Carli, G; Italian Study Group on Occupational Risk of HIV infection. The risk of occupational human immunodeficiency virus infection in health care workers: Italian multicenter study. Arch Intern Med 1993;153(12):14511458.CrossRefGoogle Scholar
22.Cardo, DM, Culver, DH, Ciesielski, CA, et al; Centers for Disease Control and Prevention Needlestick Surveillance Group. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med 1997;337(21):14851490.CrossRefGoogle Scholar
23.Mast, ST, Woolwine, JD, Gerberding, JL. Efficacy of gloves in reducing blood volumes transferred during simulated needle-stick injury. J Infect Dis 1993;168(6):15891592.CrossRefGoogle Scholar
24.Furtado, MR, Callaway, DS, Phair, JP, et al.Persistence of HIV-1 transcription in peripheral-blood mononuclear cells in patients receiving potent antiretroviral therapy. N Engl J Med 1999; 340(21):16141622.CrossRefGoogle ScholarPubMed
25.Ibáñez, A, Puig, T, Elias, J, Clotet, B, Ruiz, L, Martinez, MA. Quantification of integrated and total HIV-1 DNA after long-term highly active antiretroviral therapy in HIV-1-infected patients. AIDS 1999;13(9):10451049.CrossRefGoogle ScholarPubMed
26.Stürmer, M, Doerr, HW, Berger, A, Gute, P. Is transmission of HIV-1 in non-viraemic serodiscordant couples possible? Antivir Ther 2008;13(5):729732.Google ScholarPubMed
27.Tubiana, R, Le Chenadec, J, Rouzioux, C, et al.Factors associated with mother-to-child transmission of HIV-1 despite a maternal viral load < 500 copies/ml at delivery: a case-control study nested in the French perinatal cohort (EPF-ANRS COI). Clin Infect Dis 2010;50(4):585596.CrossRefGoogle Scholar
28.Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, http://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. Published 2012. Accessed September 17, 2012.Google Scholar
29.Shih, CC, Kaneshima, H, Rabin, L, et al.Postexposure prophylaxis with zidovudine suppresses human immunodeficiency virus type 1 infection in SCID-hu mice in a time-dependent manner. J Infect Dis 1991;163(3):625627.CrossRefGoogle Scholar
30.Tsai, CC, Emau, P, Follis, KE, et al.Effectiveness of postinoculation (R)-9-(2-phosphonylmethoxypropyl)adenine treatment for prevention of persistent simian immunodeficiency virus SIVmine infection depends critically on timing of initiation and duration of treatment. J Virol 1998;72(5):42654273.Google ScholarPubMed
31.Henderson, DK. Human immunodeficiency virus in health care settings. In: Mandeli, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. New York: Elsevier, 2009:37533770.Google Scholar
32.Wang, SA, Panlilio, AL, Doi, PA, White, AD, Stek, M Jr, Saah, A. Experience of healthcare workers taking postexposure prophylaxis after occupational HIV exposures: findings of the HIV Postexposure Prophylaxis Registry. Infect Control Hosp Epidemiol 2000;21(12):780785.Google ScholarPubMed
33.Swotinsky, RB, Steger, KA, Sulis, C, Snyder, S, Craven, DE. Occupational exposure to HIV: experience at a tertiary care center. / Occup Environ Med 1998;40(12):11021109.CrossRefGoogle Scholar
34.Parkin, JM, Murphy, M, Anderson, J, El-Gadi, S, Forster, G, Pinching, AJ. Tolerability and side-effects of post-exposure prophylaxis for HIV infection. Lancet 2000;355(9205):722723.CrossRefGoogle ScholarPubMed
35.Puro, V. Post-exposure prophylaxis for HIV infection: Italian Registry of Post-Exposure Prophylaxis. Lancet 2000;355(9214):15561557.CrossRefGoogle ScholarPubMed
36.Lee, LM, Henderson, DK. Tolerability of postexposure antiretroviral prophylaxis for occupational exposures to HIV. Drug Saf 2001;24(8):587597.CrossRefGoogle Scholar
37.Russi, M, Buitrago, M, Goulet, J, et al.Antiretroviral prophylaxis of health care workers at two urban medical centers. J Occup Environ Med 2000;42(11):10921100.CrossRefGoogle ScholarPubMed
38.Garb, JR. One-year study of occupational human immunodeficiency virus postexposure prophylaxis. J Occup Environ Med 2002;44(3):265270.CrossRefGoogle ScholarPubMed
39.Grime, PR, Ris, L, Binns, C, Carruthers, JR, Williams, S. Pan-Thames survey of occupational exposure to HIV and the use of post-exposure prophylaxis in 71 NHS trusts. J Infect 2001;42(l):2732.CrossRefGoogle ScholarPubMed
40.Puro, V, DeCarli, G, Soldani, F, et al.Adverse drug reactions associated with PEP. Presented at: 10th Conference on Retroviruses and Opportunistic Infections, 2003, Boston. Poster 711.Google Scholar
41.Beltrami, EM, Cheingsong, R, Heneine, WM, et al; Occupational HIV Exposure Study Group. Antiretroviral drug resistance in human immunodeficiency virus-infected source patients for occupational exposures to healthcare workers. Infect Control Hosp Epidemiol 2003;24(10):724730.CrossRefGoogle Scholar
42.Johnson, VA, Calvez, V, Günthard, HF, et al.2011 Update of the drug resistance mutations in HIV-1. Top Antivir Med 2011;19(4):156164.Google ScholarPubMed
43.Hawkins, DA, Asboe, D, Barlow, K, Evans, B. Seroconversion to HIV-1 following a needlestick injury despite combination postexposure prophylaxis. J Infect 2001;43(1):1215.CrossRefGoogle Scholar
44.Beltrami, EM, Luo, CC, de la Torre, N, Cardo, DM. Transmission of drug-resistant HIV after an occupational exposure despite postexposure prophylaxis with a combination drug regimen. Infect Control Hosp Epidemiol 2002;23(6):345348.CrossRefGoogle ScholarPubMed
45.Perdue, B, Wolfe Rufael, D, Mellors, J, Quinn, T, Margolick, J. HIV-1 transmission by a needle-stick injury despite rapid initiation of four-drug postexposure prophylaxis. Presented at: 6th Conference on Retroviruses and Opportunistic Infections, 1999, Chicago.Google Scholar
46.Lockman, S, Creek, T. Acute maternal HIV infection during pregnancy and breast-feeding: substantial risk to infants. J Infect Dis 2009;200(5):667669.CrossRefGoogle ScholarPubMed
47.Kourtis, AP. Antiretroviral drug use during pregnancy and risk of premature delivery: is there a connection? J Infect Dis 2010; 201(7):978980.CrossRefGoogle Scholar
48.Sarner, L, Fakoya, A. Acute onset lactic acidosis and pancreatitis in the third trimester of pregnancy in HIV-1 positive women taking antiretroviral medication. Sex Transm Infect 2002;78(1):5859.CrossRefGoogle ScholarPubMed
49.Mandelbrot, L, Kermarrec, N, Marcollet, A. Case report: nucleoside analogue-induced lactic acidosis in the third trimester of pregnancy. AIDS 2003;17(2):272273.CrossRefGoogle ScholarPubMed
50.Antiretroviral Pregnancy Registry Steering Committee. Antiretroviral Pregnancy Registry International Interim Report for 1 January 1989 through 31 July 2011. Wilmington, NC: Registry Coordinating Center, 2011.Google Scholar
51.Ford, N, Calmy, A, Mofenson, L. Safety of efavirenz in the first trimester of pregnancy: an updated systematic review and metaanalysis. AIDS 2011;25(18):23012304.CrossRefGoogle Scholar
52.Blanche, S, Tardieu, M, Benhammou, V, Warszawski, J, Rustin, P. Mitochondrial dysfunction following perinatal exposure to nucleoside analogues. AIDS 2006;20(13):16851690.CrossRefGoogle ScholarPubMed
53.Thorne, C, Newell, ML. Safety of agents used to prevent mother-to-child transmission of HIV: is there any cause for concern? Drug Sef 2007;30(3):203213.CrossRefGoogle ScholarPubMed
54.Mirochnick, M, Thomas, T, Capparelli, E, et al.Antiretroviral concentrations in breast-feeding infants of mothers receiving highly active antiretroviral therapy. Antimicrob Agents Chemother 2009;53(3):11701176.CrossRefGoogle ScholarPubMed
55.Benaboud, S, Pruvost, A, Coffie, PA, et al.Concentrations of tenofovir and emtricitabine in breast milk of HIV-1-infected women in Abidjan, Cote d'Ivoire, in the ANRS 12109 TEmAA study, step 2. Antimicrob Agents Chemother 2011;55(3):13151317.CrossRefGoogle ScholarPubMed
56.Shapiro, RL, Hughes, MD, Ogwu, A, et al.Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med 2010;362(24):22822294.CrossRefGoogle ScholarPubMed
57.Dryden-Peterson, S, Shapiro, RL, Hughes, MD, et al.Increased risk of severe infant anemia after exposure to maternal HAART, Botswana. J Acquir Immune Defic Syndr 2011;56(5):428436.CrossRefGoogle ScholarPubMed
58.Humphrey, JH, Marinda, E, Mutasa, K, et al; ZVITAMBO Study Group. Mother to child transmission of HIV among Zimbabwean women who seroconverted postnatally: prospective cohort study. BMJ 2010;341:c6580.CrossRefGoogle Scholar
59.Panlilio, AL, Sinkowitz-Cochran, R, Grady, MA, Cardo, DM, et al.Barriers to and facilitators of implementing U.S. Public Health Service (PHS) guidelines on occupational exposure management by emergency physicians. Presented at: 13th Annual Meeting of the Society for Healthcare Epidemiology of America, 2003, Arlington, VA. Abstract 240.Google Scholar
60.Masciotra, S, McDougal, JS, Feldman, J, Sprinkle, P, Wesolowski, L, Owen, SM. Evaluation of an alternative HIV diagnostic algorithm using specimens from seroconversion panels and persons with established HIV infections. J Clin Virol 201l;52(suppl 1):S17S22.CrossRefGoogle Scholar
61.Branson, BM. The future of HIV testing. J Acquir Immune Defic Syndr 2010;55(suppl 2):S102S105.CrossRefGoogle ScholarPubMed
62.Chavez, P, Wesolowski, L, Patel, P, Delaney, K, Owen, SM. Evaluation of the performance of the Abbott ARCHITECT HIV Ag/Ab combo assay. J Clin Virol 2011;52(suppl 1):S51S55.CrossRefGoogle ScholarPubMed
63.Often, RA, Smith, DK, Adams, DR, et al.Efficacy of postexposure prophylaxis after intravaginal exposure of pig-tailed macaques to a human-derived retrovirus (human immunodeficiency virus type 2). J Virol 2000;74(20):97719775.Google Scholar
64.Tsai, CC, Follis, KE, Sabo, A, et al.Prevention of SIV infection in macaques by (R)-9-(2-phosphonylmethoxypropyl)adenine. Science 1995;270(5239):11971199.CrossRefGoogle ScholarPubMed
65.Gulick, RM, Mellors, JW, Havlir, D, et al.Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. N Engl J Med 1997;337(ll):734739.CrossRefGoogle ScholarPubMed
66.Hirsch, M, Steigbigel, R, Staszewski, S, et al.A randomized, controlled trial of indinavir, zidovudine, and lamivudine in adults with advanced human immunodeficiency virus type 1 infection and prior antiretroviral therapy. J Infect Dis 1999;180(3):659665.CrossRefGoogle ScholarPubMed
67.Wheeler, WH, Ziebell, RA, Zabina, H, et al; Variant, Atypical, and Resistant HIV Surveillance Group. Prevalence of transmitted drug resistance associated mutations and HIV-1 subtypes in new HIV-1 diagnoses, U.S.—2006. AIDS 2010;24(8):12031212.CrossRefGoogle ScholarPubMed
68.Kim, D, Wheeler, W, Ziebell, R, et al.Prevalence of transmitted antiretroviral drug resistance among newly-diagnosed HIV-1-infected persons, US, 2007. Presented at: CROI 2010: 17th Conference on Retroviruses and Opportunistic Infections, 2010, San Francisco.Google Scholar
69.Scherzer, R, Estrella, M, Li, Y, et al.Association of tenofovir exposure with kidney disease risk in HIV infection. AIDS 2012; 26(7):867875.CrossRefGoogle ScholarPubMed
70.Cattelan, AM, Erne, E, Salatino, A, et al.Severe hepatic failure related to nevirapine treatment. Clin Infect Dis 1999;29(2):455456.CrossRefGoogle ScholarPubMed
71.Johnson, S, Baraboutis, JG. Adverse effects associated with use of nevirapine in HIV postexposure prophylaxis for 2 health care workers. JAMA 2000;284(21):27222723.CrossRefGoogle ScholarPubMed
72.Centers for Disease Control and Prevention. Serious adverse events attributed to nevirapine regimens for postexposure prophylaxis after HIV exposures—worldwide, 1997-2000. MMWR Morb Mortal Wkly Rep 2001;49(51-52):11531156.Google Scholar
73.Armstrong, K, Görden, R, Santorella, G. Occupational exposure of health care workers (HCWs) to human immunodeficiency virus (HIV); stress reactions and counseling interventions. Soc Work Health Care 1995;21(3):6180.CrossRefGoogle ScholarPubMed
74.Meienberg, F, Bucher, HC, Sponagel, L, Zinkernagel, C, Gyr, N, Battegay, M. Anxiety in health care workers after exposure to potentially HIV-contaminated blood or body fluids. Swiss Med Wkly 2002; 132 (23-24):321324.Google ScholarPubMed
75.Bentsen, C, McLaughlin, L, Mitchell, E, et al.Performance evaluation of the Bio-Rad Laboratories GS HIV Combo Ag/Ab EIA, a 4th generation HIV assay for the simultaneous detection of HIV p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2 in human serum or plasma. J Clin Virol 2011; 52(suppl 1):S57S61.CrossRefGoogle ScholarPubMed
76.Ridzon, R, Gallagher, K, Ciesielski, C, et al.Simultaneous transmission of human immunodeficiency virus and hepatitis C virus from a needle-stick injury. N Engl J Med 1997;336(13):919922.CrossRefGoogle ScholarPubMed
77.Ciesielski, CA, Metler, RP. Duration of time between exposure and seroconversion in healthcare workers with occupationally acquired infection with human immunodeficiency virus. Am J Med 1997;102(5B):115116.CrossRefGoogle ScholarPubMed
202
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Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis
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