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HIV Needlestick Injury - Immediate Protocol for Healthcare Workers

TIME IS CRITICAL. Every minute counts. PEP must start within 72 hours - ideally within 1-2 hours.

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STEP 1 - Immediate First Aid (Do This NOW)

1. Do NOT panic - the average risk of HIV transmission from a single needlestick is only 0.3%
2. Remove the needle carefully - do not put it back on the patient or recap it
3. Wash the wound immediately with soap and running water for several minutes
4. Do NOT squeeze/milk the wound, suck it, or apply bleach or caustic agents - this can worsen tissue damage
5. If it is a mucous membrane exposure (splash to eye/mouth): irrigate copiously with clean water or sterile saline
6. Let the wound bleed freely for a short time, then cover with a clean dressing

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STEP 2 - Report Immediately (Within Minutes)

1. Report to your supervisor / charge nurse / team leader immediately
2. Go to the Occupational Health Department or the Emergency Department (whichever is available faster, especially outside working hours)
3. Do NOT wait until the next day - this is a medical emergency
4. Fill out an incident report / accident form - this is both for your protection and for legal/insurance purposes

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STEP 3 - Assessment at the Clinic/ED

• The needle was visibly contaminated with blood
• The needle was used in a vein or artery
• The wound was deep
• The source patient has a high viral load or advanced HIV

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STEP 4 - Post-Exposure Prophylaxis (PEP) - The Key Treatment

Preferred PEP Regimen (adults):

• Tenofovir disoproxil fumarate (TDF) 300 mg + Emtricitabine (FTC) 200 mg (often as a single pill: Truvada) - once daily
• PLUS either:
  • Raltegravir (Isentress) 400 mg twice daily, OR
  • Dolutegravir (Tivicay) 50 mg once daily

Duration:

• 28 days (4 weeks) of continuous treatment - do NOT stop early even if side effects occur

Important notes:

• If the source patient is later confirmed HIV-negative, PEP can be stopped
• If the source is confirmed HIV-positive, complete the full 28-day course
• Side effects include nausea, fatigue, headache - take with food to reduce nausea
• Adherence is critical - missing doses reduces effectiveness significantly

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STEP 5 - Blood Tests (Baseline and Follow-up)

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STEP 6 - Hepatitis B Check

• If you are vaccinated against hepatitis B and have protective antibody levels - you are safe
• If not vaccinated or unsure - hepatitis B immunoglobulin (HBIG) and/or vaccine should be given immediately
• There is currently no PEP available for Hepatitis C - only monitoring is done

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STEP 7 - Counselling and Support

• You will receive pre- and post-test counselling
• You should avoid unprotected sex and do not donate blood during the 6-month follow-up period
• Inform your partner; condom use is advised during this time
• Psychological support is important - this event can cause significant stress and anxiety

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Summary Timeline

0 minutes    → Wash wound, first aid
ASAP         → Report to supervisor
< 1-2 hours  → Go to Occupational Health / ED, start PEP
< 72 hours   → ABSOLUTE DEADLINE to start PEP
Day 0        → Baseline blood tests
28 days      → Complete full PEP course
6 weeks      → HIV test
12 weeks     → HIV test
6 months     → Final HIV test

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Remember

• The risk is low (0.3%), but you must act quickly for the best outcome
• PEP is highly effective when started promptly and completed fully
• Do not be embarrassed - needlestick injuries happen to experienced staff and are well-recognized occupational hazards
• Every hospital must have a written protocol for this - ask your supervisor for it

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Disclaimer: This is general medical information. Please follow your hospital's specific protocol and consult your occupational health doctor immediately.

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Is There an Antidote for HIV?

Short Answer: No traditional antidote exists - but PEP is the emergency treatment.

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What PEP Actually Does (The Nearest Thing to an Antidote)

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Why PEP is NOT a Perfect Antidote

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Is There Anything Being Researched?

• HIV vaccines - to prevent infection before exposure (none fully approved yet)
• Broadly Neutralising Antibodies (bNAbs) - injections that could block HIV, used experimentally
• Gene therapy / CRISPR - research into cutting HIV DNA out of infected cells (still experimental)
• HIV cure research - "shock and kill" or "block and lock" strategies (not yet available clinically)

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Bottom Line

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Side Effects of PEP Medications

Overview

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Drug 1: Tenofovir + Emtricitabine (Truvada) - The Backbone

Common Side Effects (affect up to 1 in 10 people):

Tenofovir-Specific Concerns (longer term / rarer):

Emtricitabine-Specific:

• Skin hyperpigmentation (darkening of skin, especially palms/soles) - more common in darker-skinned individuals, usually reversible
• In people with hepatitis B co-infection: stopping emtricitabine abruptly can cause a hepatitis B flare - always taper under medical supervision

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Drug 2: Raltegravir (Isentress) - Taken Twice Daily

Common Side Effects:

Rare but Serious:

• Rhabdomyolysis - severe muscle breakdown leading to kidney problems (rare; more risk if also on statins)
• Hypersensitivity reaction - rash combined with fever, seek medical attention immediately

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Drug 2 (Alternative): Dolutegravir (Tivicay) - Taken Once Daily

Common Side Effects:

Rare but Serious:

• Hepatotoxicity (liver damage) - very rare but reported
• Hypersensitivity reaction (rash + fever) - seek help immediately
• Neural tube defects - dolutegravir should be avoided in early pregnancy due to risk to the fetus

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Side Effects Comparison at a Glance

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WARNING Signs - See a Doctor Immediately If You Have:

• Severe rash with fever (may be allergic/hypersensitivity reaction)
• Muscle weakness or very dark urine (may be rhabdomyolysis)
• Yellowing of skin/eyes (jaundice - liver problem)
• Severe abdominal pain (pancreatitis)
• Thoughts of self-harm or depression (especially with dolutegravir)

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How to Manage Common Side Effects at Home

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Most Important Rule

Do NOT stop PEP because of side effects without talking to your doctor first. Side effects are temporary. Stopping PEP early means HIV may not be prevented. Your doctor can adjust doses, prescribe relief medications, or switch to a more tolerable regimen.