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Post-exposure prophylaxis
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=== History === [[Zidovudine|AZT]] was approved as a treatment for [[AIDS]] in 1987. Healthcare workers would occasionally be exposed to [[HIV]] during work. Some people{{who|date=November 2017}} thought to try giving health care workers AZT to prevent [[seroconversion]]. This practice dramatically decreased the incidence of seroconversion among health workers when done under certain conditions.<ref name="healthcareworkers">{{Cite journal | last1 = Cardo | first1 = D. M. | last2 = Culver | first2 = D. H. | last3 = Ciesielski | first3 = C. A. | last4 = Srivastava | first4 = P. U. | last5 = Marcus | first5 = R. | last6 = Abiteboul | first6 = D. | last7 = Heptonstall | first7 = J. | last8 = Ippolito | first8 = G. | last9 = Lot | first9 = F. | last10 = McKibben | doi = 10.1056/NEJM199711203372101 | first10 = P. S. | last11 = Bell | first11 = D. M. | title = A Case–Control Study of HIV Seroconversion in Health Care Workers after Percutaneous Exposure | journal = New England Journal of Medicine | volume = 337 | issue = 21 | pages = 1485–1490 | year = 1997 | pmid = 9366579 | doi-access = free }}</ref> Later the questions arose of whether to give HIV treatment after known exposure or high risk of exposure. Early data from [[Preclinical development|preclinical studies]] established the efficacy of AZT in preventing transmission of HIV infection.<ref>{{cite journal|last1=Shih|first1=CC|last2=Kaneshima|first2=H|last3=Rabin|first3=L|last4=Namikawa|first4=R|last5=Sager|first5=P|last6=McGowan|first6=J|last7=McCune|first7=JM|title=Postexposure prophylaxis with zidovudine suppresses human immunodeficiency virus type 1 infection in SCID-hu mice in a time-dependent manner.|journal=The Journal of Infectious Diseases|date=March 1991|volume=163|issue=3|pages=625–7|pmid=1995734|doi=10.1093/infdis/163.3.625}}</ref> AZT was also seen to reduce maternal-infant transmission of HIV in a [[randomized controlled trial]], suggesting AZT's post-exposure prophylaxis (PEP) use.<ref>{{cite journal|last1=Connor|first1=EM|last2=Sperling|first2=RS|last3=Gelber|first3=R|last4=Kiselev|first4=P|last5=Scott|first5=G|last6=O'Sullivan|first6=MJ|last7=VanDyke|first7=R|last8=Bey|first8=M|last9=Shearer|first9=W|last10=Jacobson|first10=RL|title=Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group.|journal=The New England Journal of Medicine|date=3 November 1994|volume=331|issue=18|pages=1173–80|doi=10.1056/NEJM199411033311801|pmid=7935654|s2cid=13457499|doi-access=free}}</ref> Subsequent data show [[Management of HIV/AIDS|combination antiretroviral therapy]] is significantly superior than AZT in reducing perinatal transmission rates.<ref>{{cite journal|last1=Watts|first1=DH|title=Management of human immunodeficiency virus infection in pregnancy.|journal=The New England Journal of Medicine|date=13 June 2002|volume=346|issue=24|pages=1879–91|doi=10.1056/NEJMra013338|pmid=12063373}}</ref> In addition, AZT is generally no longer recommended due to poor tolerance resulting in high rates of patient noncompliance.{{citation needed|date=January 2021}} Non-occupational exposures include cases when a condom breaks while a person with HIV has sex with an HIV-negative person in a single incidence, or in the case of unprotected sex with an anonymous partner, or in the case of a non-habitual incident of sharing a syringe for [[Drug injection|injection drug use]]. Evidence suggests that PEP also reduces the risk of HIV infection in these cases.<ref>{{Cite journal | last1 = Katz | first1 = M. H. | last2 = Gerberding | first2 = J. L. | doi = 10.1056/NEJM199704103361512 | title = Postexposure Treatment of People Exposed to the Human Immunodeficiency Virus through Sexual Contact or Injection-Drug Use | journal = New England Journal of Medicine | volume = 336 | issue = 15 | pages = 1097–1100 | year = 1997 | pmid = 9091810}}</ref> In 2005, the [[United States Department of Health and Human Services|US DHHS]] released the first recommendations for non-occupational PEP (nPEP) use to lower risk of HIV infection after exposures. The recommendations were replaced with an updated guideline in 2016.<ref name=":0">{{cite web | url=https://www.cdc.gov/hiv/pdf/programresources/cdc-hiv-npep-guidelines.pdf | title=Updated Guidelines for Antiretroviral Postexposure Prophylaxis After Sexual, Injection Drug Use, or Other Nonoccupational Exposure to HIV— United States, 2016 | publisher=Centers for Disease Control and Prevention, U.S. Department of Health and Human Services | access-date=June 24, 2016 | archive-date=November 20, 2016 | archive-url=https://web.archive.org/web/20161120134302/http://www.cdc.gov/hiv/pdf/programresources/cdc-hiv-npep-guidelines.pdf | url-status=live }}</ref> Occupational exposures include needlestick injury of health care professionals from an HIV-infected source. In 2012, the [[United States Department of Health and Human Services|US DHHS]] included guidelines on occupational PEP (oPEP) use for individuals with HIV exposures occurring in health care settings.<ref>{{cite journal|last1=Kuhar|first1=David T.|last2=Henderson|first2=David K.|last3=Struble|first3=Kimberly A.|last4=Heneine|first4=Walid|last5=Thomas|first5=Vasavi|last6=Cheever|first6=Laura W.|last7=Gomaa|first7=Ahmed|last8=Panlilio|first8=Adelisa L.|title=Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis|journal=Infection Control and Hospital Epidemiology|pages=875–892|doi=10.1086/672271|date=2013|pmid=23917901|volume=34|issue=9|s2cid=17032413|url=https://zenodo.org/record/1235708|access-date=2018-11-04|archive-date=2019-06-23|archive-url=https://web.archive.org/web/20190623220711/https://zenodo.org/record/1235708|url-status=live}}</ref> Since taking HIV-attacking medications shortly after exposure was proven to reduce the risk of contracting HIV, this led to research into [[pre-exposure prophylaxis]] by taking medication before a potential exposure to HIV occurred.<ref>{{cite journal | last1=Desai | first1=Monica | last2=Field | first2=Nigel | last3=Grant | first3=Robert | last4=McCormack | first4=Sheena | title=State of the art review: Recent advances in PrEP for HIV | journal=BMJ (Clinical Research Ed.) | volume=359 | date=2017-12-11 | pages=j5011 | pmid=29229609 | doi=10.1136/bmj.j5011 | pmc=6020995 }}</ref> A report from early 2013 revealed that a female baby born with the HIV virus displayed no sign of the virus two years after high doses of three antiretroviral drugs were administered within 30 hours of her birth. The findings of the case were presented at the 2013 Conference on Retroviruses and Opportunistic Infections in [[Atlanta]], U.S. and the baby is from [[Mississippi]], U.S. The baby—known as the "[[Mississippi baby]]"—was considered to be the first child to be "functionally cured" of HIV.<ref>{{cite news|url=https://edition.cnn.com/2013/03/03/health/hiv-toddler-cured|title=Researchers: Toddler cured of HIV|author=Saundra Young|date=4 March 2013|newspaper=CNN|access-date=4 July 2013|archive-date=19 May 2013|archive-url=https://web.archive.org/web/20130519070343/http://edition.cnn.com/2013/03/03/health/hiv-toddler-cured|url-status=live}}</ref> However, HIV re-emerged in the child as of July 2014.<ref>{{cite news|url=https://www.niaid.nih.gov/news/newsreleases/2014/Pages/MississippiBabyHIV.aspx|title="Mississippi Baby" Now Has Detectable HIV, Researchers Find|author=National Institute of Allergy and Infectious Diseases|date=10 July 2014|newspaper=NIH|access-date=12 August 2014|archive-date=9 September 2016|archive-url=https://web.archive.org/web/20160909164118/http://www.niaid.nih.gov/news/newsreleases/2014/Pages/MississippiBabyHIV.aspx|url-status=live}}</ref>
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