What post-exposure prophylaxis is recommended for patients exposed to HIV through a needlestick injury?

Post-exposure prophylaxis (PEP) for HIV following a needlestick injury:

• PEP is considered a medical emergency and requires prompt assessment and treatment with antiretroviral therapy (ART) if the exposure is occupational and the source is known or suspected to be HIV-positive.
• Immediate management includes thorough cleaning of the exposed site: skin wounds should be washed with soap and water, mucous membranes irrigated with water, and puncture wounds encouraged to bleed freely but not sucked.
• PEP should ideally be started as soon as possible, preferably within 24 hours, and no later than 72 hours after exposure.
• For occupational exposures, local NHS policies should be followed, and rapid access to urgent advice and PEP is usually available via Accident and Emergency departments.
• In contrast, for needlestick injuries in the community (e.g., from discarded needles), PEP is generally not recommended because the risk of HIV transmission is extremely low and it is usually not possible to determine if the needle was used, the HIV status of the source, or the time since use.
• If there are factors that increase the probability of HIV transmission in community needlestick injuries, expert advice from an HIV specialist or Accident and Emergency should be sought.

Follow-up HIV testing is recommended at 8–12 weeks after exposure, and patients should be advised to attend for regular sexual health checks.

Overall, PEP is recommended for occupational needlestick injuries with known or suspected HIV exposure, but not routinely for community needlestick injuries unless risk factors are present and expert advice is obtained.

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