Question 2 - Occupational Postexposure Prophylaxis Question Bank

Prevention of HIV.

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Occupational Postexposure ProphylaxisQuestion 2/10

A 46-year-old nurse is splashed in the eye with urine from a patient with HIV and advanced immunodeficiency. The source patient’s initial laboratory studies obtained 1 day prior showed a CD4 count of 172 cells/mm³, and the plasma HIV RNA test is pending. The splash happened when the nurse was inserting a urinary catheter, and he did not see any visible blood in the urine. He rinsed his eye immediately with water and presented to employee health within 1 hour of the incident.

What would be the next step in the management of this incident?

Wait for the result of the source patient’s plasma HIV RNA level to further assess the risk of exposure

Since the source patient has a CD4 cell count less than 200 cells/mm³, antiretroviral postexposure prophylaxis is indicated

Since the nurse’s conjunctivae were exposed to urine, the risk of HIV transmission is high, and antiretroviral postexposure prophylaxis is indicated

Since the nurse was exposed to urine without blood contamination, no antiretroviral postexposure prophylaxis is indicated

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Question Last Updated
December 3rd, 2025

Table 1. **USPS Guidelines for the Use of Antiretroviral Agents for Occupational Exposures to HIV**

HIV Postexposure Prophylaxis Regimens
Preferred HIV Postexposure Prophylaxis Regimen Raltegravir (400 mg twice daily) plus Tenofovir DF-Emtricitabine (300 mg-200 mg [1 tablet] daily)
Alternative HIV Postexposure Prophylaxis Regimens May combine 1 anchor drug or drug pair from the left column with 1 pair of nucleoside/nucleotide reverse transcriptase inhibitors from the right column; prescribers unfamiliar with these agents/regimens should consult clinicians who are familiar with the agents and their toxicities^a
Anchor Drug Raltegravir Darunavir + ritonavir Etravirine Rilpivirine Atazanavir + ritonavir Lopinavir-ritonavir	Nucleoside Reverse Transcriptase Inhibitors Tenofovir DF-emtricitabine Tenofovir DF + lamivudine Zidovudine-lamivudine Zidovudine + emtricitabine
The following alternative is a complete fixed-dose combination regimen, and no additional antiretroviral medications are needed: Elvitegravir-cobicistat-tenofovir DF-emtricitabine
Alternative Agents for Use as PEP Only with Expert Consultation Abacavir Efavirenz Enfuvirtide Fosamprenavir Maraviroc Saquinavir Stavudine		Agents Generally Not Recommended for Use as PEP Didanosine Nelfinavir Tipranavir	Agents Contraindicated as PEP Nevirapine
Note. For consultation or assistance with HIV PEP, contact the National Clinician Consultation Center’s Post-Exposure Prophylaxis Hotline at telephone number 888-448-4911 or visit its website at http://nccc.ucsf.edu/ ^aThe alternatives regimens are listed in order of preference; however, other alternatives may be reasonable based on patient and clinician preference.

Source:

Kuhar DT, Henderson DK, Struble KA, et al. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. Infect Control Hosp Epidemiol. 2013;34:875-92. [PubMed Abstract]

Table 1.
Relative Risk of Fluids in Occupational Exposure to HIV
Category of Infectivity	Fluid
Infectious Fluids	Blood
Infectious Fluids	Visible bloody body fluids
Potentially Infectious Body Fluids	Semen and vaginal secretions
	Cerebrospinal fluid
	Synovial fluid
	Pleural fluid
	Peritoneal fluid
	Pericardial fluid
	Amniotic fluid
Not considered infectious	Nasal secretions
	Saliva
	Sputum
	Vomitus
	Feces
	Urine
	Sweat and tears
^*Note: although semen and vaginal secretions are known to be infectious for HIV in sexual exposures, they have not been implicated in transmissions in the occupational setting.

Source:

Kuhar DT, Henderson DK, Struble KA, et al. Updated US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis. Infect Control Hosp Epidemiol. 2013;34:875-92. [PubMed Abstract]

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Single-Tablet Regimens

Long-Acting Injectable Regimens

Capsid Inhibitors

Entry Inhibitors

Integrase Strand Transfer Inhibitors (INSTI)

Nucleoside Reverse Transcriptase Inhibitors (NRTI)

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)

Protease Inhibitors (PI)

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Prevention of HIV.

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Occupational Postexposure ProphylaxisQuestion 2/10

Questions in Topic

What would be the next step in the management of this incident?

HIV Postexposure Prophylaxis Regimens

Relative Risk of Fluids in Occupational Exposure to HIV

Infectious Fluids

Potentially Infectious Body Fluids

Not considered infectious

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