Exposición laboral a los virus de la hepatitis B y C y al virus de la inmunodeficiencia humana / Occupational exposure to hepatitis B virus, hepatitis C virus, or human immunodeficiency virus

ABSTRACT

This document summarizes key recommendations on assisting health care personnel who have experienced occupational exposure to blood or other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV). The document isbased on a report prepared jointly by four agencies of the Government of the United States of America the Centers for Disease Control and Prevention, the Food and Drug Administration, the Health Resources and Services Administration, and the National Institutes of Health. Their report updated and consolidated earlier guidelines from the Public Health Service of the United States. With respect to HBV it is recommended that postexposure management include initiation of the hepatitis B vaccine series to any susceptible, unvaccinated person. When either the source is positive for the hepatitis B surface antigen or the exposed individual has not been vaccinated or, if in spite of being vaccinated, had not developed an adequate antibody response, vaccination should be accompanied by the administration of hepatitis B immunoglobulin. With HCV exposure the administration of immunoglobulins or of antiviral agents (e.g., interferon with or without ribavirin) is not recommended. The appropriate measures consist of determining if the source and the exposed individual are infected. If the source is HCV-positive, the exposed person should undergo follow-up HCV testing in order to determine if infection develops. The recommendations for prophylaxis after exposure to HIV consist of, in the majority of cases, administering for 4 weeks a basic regimen of two drugs (zidovudine (ZDV) and lamivudine (3TC), lamivudine and stavudine (d4T), or stavudine and didanosine (ddI)). Where there is a higher risk of transmission, this basic regimen can be expanded with the addition of a third antiretroviral. The report also considers various special circumstances such as a delay in reporting the exposure, exposure to substances from an unknown individual, exposure during pregnancy, resistance of the source virus to antiretroviral agents, and toxicity of the postexposure regimen