Background: Occupational exposure to blood-borne pathogens requires urgent evaluation and treatment. The 2001, U.S. Public Health Service (USPHS) Guidelines provide specific recommendations for managing exposures and initiating post-exposure prophylaxis (PEP). Expert consultation from the National Clinicians’ Post-exposure Prophylaxis Hotline (PEPline) or other experts is recommended for complicated exposures and for clinicians without PEP expertise or experience with antiretroviral (ARV) drug therapy. The PEPline, based at UCSF San Francisco General Hospital and supported by the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC), provides immediate nationwide 24-hour PEP consultation at 888/448-4911. Because unnecessary or excessive ARV use for PEP can cause serious drug toxicity, we reviewed PEPline calls to determine whether unnecessary drug therapy was being administered to healthcare workers (HCWs) in these settings.

Methods: The PEPline received 9,741 reported exposure calls for the period 9/1/00–8/31/02. We compared these self-reported exposures to USPHS exposure definitions to determine actual exposures. We then assessed PEPline recommendations for the subset of HCWs who had been given antiretroviral PEP drugs prior to the PEPline call.

Results: Of reported exposures, 7,924 (81%) were determined to be actual exposures based on USPHS definitions. Of actual exposures, 1,469 (19%) had been given ARV PEP. The PEPline recommended discontinuing PEP (37%) or decreasing drugs (21%), usually from 3 or 4 drugs to 2 drugs, in 58% of HCWs in whom ARV PEP had been initiated. No change was recommended in 35% of exposures. Increasing drugs was recommended in 7.4%.

Conclusions: Expert consultation can be essential in assessing the need for PEP, selecting ARV regimens, interpreting USPHS Guidelines, and minimizing unnecessary drug toxicity by decreasing or discontinuing PEP regimens. PEPline clinicians helped callers clarify non-exposure in almost 1/5 of cases and recommended changes to PEP regimen nearly 2/3 of the time HCWs had been started on PEP.

 

Recommendations for 1,469 HCWs started on PEP

No change	509	34.7%
Increase number of drugs in PEP regimen	108	7.4%	p = 0.001*
Decrease number of drugs in PEP regimen	313	21.3%	p = 0.001
Stop PEP	539	36.7%	p = 0.001

*p = significant difference from reference category, no change.