Note: No scientific evidence exists as to the fact that the use of antiseptics for wound care or squeezing the wound will reduce the risk of transmission of HIV. However, use of antiseptics is not contraindicated. The use of a caustic agent such as bleach is not recommended.

One must report an "exposure" immediately to the appropriate authorities and condition must be treated as an emergency. Prompt reporting is essential because in some cases, HIV post exposure prophylaxis (PEP) may be recommended and it should be started as soon as possible, preferably within a few hours. Initiating treatment after 72 hours of exposure is usually not recommended.

Various animal studies have been done over the years and these have provided encouraging evidence of post exposure chemo prophylactic efficacy. It has also been shown that delaying initiation, shortening the duration or decreasing the anti retroviral dose of PEP, individually or in combination, decreased its prophylactic efficacy

However, little information exists about efficacy of PEP in humans as seroconversion is infrequent following an occupational exposure to HIV infected blood, it would need thousands of HCP to enroll in prospective study to achieve the statistically significant results on efficacy of PEP

However, in a retrospective case control study of HCP, it was demonstrated that use of Zidovudine as PEP was associated with a reduction in the risk of HIV infection by approximately 81%.

Also our experience in HIV infected patients has shown that combination of different anti retroviral agent is superior to monotherapy regimen, so a combination of two or three drugs in PEP regimen should be more beneficial than single drug. One needs to consider toxicity of a combination regimens vis-a-vis risk of transmission. NRTI combinations being considered for PEP includes Zidovudine (ZDV) & Lamivudine (3TC), 3TC & Stavudine (d4T), and Didanosine (ddI) & d4T. In previous regimens ZDV & 3 TC was considered first regimen but emerging resistance to ZDV & 3TC in certain geographical areas might demand different initial combinations. The addition of a third drug for PEP in high risk exposures is based on their demonstrated effectiveness in reducing viral burden in HIV infected persons. Previously Indinavir (IDV) or Nelfinavir (NFV) were recommended as first choice agents in "expanded PEP regimens". But now with chances of PI resistance particularly on exposure to patients who are on triple therapy, Efavirenz (FFV) and Abacavir (ABC) are being considered as alternatives. However, Nevirapine (NVP) has not been recommended for use in PEP regimen.

Failure of PEP to prevent HIV infection in HCP has been reported in at least 21 cases (16 on ZDV, two on ZDV and ddI and three on triple drug combination).