The transmission of HIV from patient to healthcare worker in an occupational setting was first documented in 1984 (1). In countries that have surveillance and HIV testing systems to recognise occupationally acquired cases, over 100 cases of HIV transmission after an occupational exposure were reported worldwide up to June 1999 (2). Antiretroviral drugs are used for post-exposure prophylaxis (PEP), and zidovudine alone is said to reduce transmission of HIV by 81% (3), but failures of PEP have been documented (4). The European Commission has recently funded a project to develop guidelines for the standardised management of occupational exposures to HIV/bloodborne infections and evaluation of PEP in Europe. The EuRoPEP (European Registry of Post-Exposure Prophylaxis) project is coordinated by the Istituto Nazionale per le Malattie Infettive, Lazzaro Spallanzani, Rome, and involves a group of expert representatives from Croatia, Denmark, France, Germany, Italy, Portugal, Spain, Switzerland, and the United Kingdom. The group presented two abstracts at the XIV International AIDS Conference in Barcelona, Spain (7-12 July 2002, http://www.aids2002.com/). The first assessed current policies and practice for the management of occupational exposures and PEP (5); the second aimed to provide a set of recommendations based on a review of national management strategies as discussed during a consensus meeting (6), and copies are available on request: (irapep@inmi.it).

Of the nine countries participating in the study, all had current guidelines and systems for surveillance of occupational exposure to HIV. The time limit for using PEP ranged from 24 hours to 2 weeks after exposure. The guidelines propose discouraging PEP after 72 hours.

All nine countries routinely recommend three antiretroviral drugs as PEP, four countries, however, had the option for dual antiretrovirals as PEP, based on an assessment of risk. The guidelines propose three drug PEP routinely, with the clinical decision on whether PEP is to be given based on assessment of the exposure, material, and source risk factors (table 1) (6).

Table1. Proposed European recommendations for post-exposure prophylaxis against HIV infection in healthcare workers.

Click here to view table in new window

The proposed standard initial PEP regime recommends zidovudine 300mg + lamivudine 150mg (or Combivir 1 capsule) + nelfinavir 1,250 mg orally, twice a day. Nevirapine is not recommended as part of the standard four week PEP regimen because of its severe adverse reactions (7). None of the nine countries routinely included nevirapine as part of standard PEP.

All countries routinely performed follow up testing at baseline, between one to three months and six months, with two countries performing a further test at one year (5).

The proposed guidelines recommend testing at baseline, four, 12, and 24 weeks, with additional monitoring at week one and two as compliance with and tolerance of the regimen can highlight adverse reactions and potential toxicity (6).

The recommendation to perform rapid HIV antibody testing of the source patient, to identify those who are not HIV infected, will reduce the inappropriate use of PEP.

The overall aim of the EuRoPEP project is to improve the outcome for healthcare workers exposed to HIV. EuRoPEP shows that there are many similarities in management of exposed healthcare workers from the nine European countries involved, but a number of differences remain. EuRoPEP’s proposed recommendations provide a way to harmonise the management of PEP and surveillance data in Europe. The proposed guidelines seek to maximise the effect of PEP, minimise the adverse reactions, and reduce the use of PEP in incidents where it is not appropriate.