De haalbaarheid en de zin. Post-expositie-profylaxe

The mean risk of acquiring HIV from a needle stick or a mucous membrane accident with HIV-infected blood is 0.3% and 0.1%, respectively. Factors increasing the risk of HIV transmission from percutaneous exposure include a deep injury, visible blood on the needle, a procedure with a hollow needle lying within a vessel, and a high plasma viral load in the host. A retrospective case control study among health care workers, the efficacy of zidovudine in preventing vertical HIV transmission, and the efficacy of current antiretroviral combination regimens in suppressing viral replication, resulted in new guidelines for post-exposure prophylaxis in the health care setting. The application of the guidelines in day-to-day practice is feasible, and treatment is usually completed. Toxicity is frequent, but most often mild and reversible. Of serious concern is the observation of a small number of severe adverse events related to antiretroviral drugs, i.e. nephrolithiasis (due to indinavir) and toxic hepatitis (due to nevirapine). In the Netherlands so far no HIV infection has been reported after an occupational accident.