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The Management of Occupational Exposures to HIV test
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Definition of Health-Care Personnel and Exposure
1. The term HCP refers to all paid and unpaid persons working in healthcare settings who have the potential for exposure to infectious materials including body substances, contaminated medical supplies and equipment, or contaminated environmental surfaces.
2. Which of the following is not considered potentially infectious unless they are visibly bloody?
A. Cerebrospinal fluid
C. Amniotic fluid
D. Vaginal secretions
Risk for Occupational Transmission of HIV
3. In prospective studies of HCP, the average risk for HIV transmission after a percutaneous exposure to HIV-infected blood has been estimated to be approximately _____%.
Toxicity and Drug Interactions of Antiretroviral Agents
4. How long should a person receiving PEP take to complete a full regimen?
A. 2 weeks
B. 4 weeks
C. 6 weeks
D. 8 weeks
5. Anecdotal evidence from clinicians knowledgeable about HIV treatment indicates that antiretroviral agents are tolerated more poorly by HIV-infected patients on antiretroviral medications that by HCP taking HIV PEP.
6. Of the antiretroviral classes of drugs currently available to treat HIV infections, which have the greatest potential for interactions with other drugs?
A. Protease inhibitors and nonnucleoside reverse transcriptase inhibitors
B. Nucleoside and nucleotide reverse transcriptase inhibitors
C. Fusion inhibitors
D. Integrase strand transfer inhibitors and chemokine receptor 5 antagonists
Resistance to Antiretroviral Agents
7. If a source patient is known to harbor drug-resistant HIV, expert consultation is recommended for selection of an optimal PEP regimen, therefore the HCP exposed should delay the initiation of HIV PEP while awaiting expert consultation.
Antiretroviral Drugs During Pregnancy and Lactation
8. In general, antiretroviral drug toxicity has not been shown to be increased in pregnancy, however, physiologic changes that occur during pregnancy may alter antiretroviral drug metabolism, and, therefore optimal drug dosing.
9. Which antiretroviral drug results in high levels of penetration into breast milk?
A. Protease inhibitors
D. None of the above
Management of Occupational Exposure by Emergency Physicians
10. Many HCP exposures to HIV occur outside of occupational health clinic hours of operation, or at sites at which occupational health services are unavailable, and initial exposure management is often overseen by emergency physicians or other providers who are not experts in the treatment of HIV infection or the use of antiretroviral medications.
11. Reevaluation of exposed HCP is recommended within _______ post-exposure, especially, as additional information about the exposure or source person become available.
A. 24 hours
B. 36 hours
C. 48 hours
D. 72 hours
Source Patient HIV Testing
12. Which HIV test allows identification of most infections during the “window period”?
A. Fourth-generation combination p24 antigen-HIV antibody (Ag/Ab) tests.
B. FDA-approved rapid tests.
C. First and second generation enzyme immunoassays.
D. Third generation chemiluminescent immunoassays.
Recommendations for the Selection of Drugs for HIV PEP
13. PHS recommends that the severity of exposure be used to determine the number of drugs to be offered in an HIV PEP regimen.
14. After baseline testing at the time of exposure, follow-up testing should be performed at:
A. 6 weeks
B. 12 weeks
C. 6 months
D. All of the above
BOX 1. Situations for Which Expert Consultation for Human Immunodeficiency Virus (HIV) Postexposure Prophylaxis (PEP) is Recommended
15. If the source of exposure is unknown (e.g., needle in sharps disposal container), the needle or other sharp instruments should be tested for HIV.
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