2025 US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Post-exposure Prophylaxis in Healthcare Settings

TL;DR

These updated guidelines provide new recommendations for managing occupational HIV exposures and post-exposure prophylaxis in healthcare settings.

Contribution

The guidelines introduce updated antiretroviral regimens, shortened testing periods, and revised toxicity monitoring practices for post-exposure prophylaxis.

Findings

New antiretroviral drug regimens for post-exposure prophylaxis (PEP) are recommended.

Follow-up HIV testing duration has been shortened.

Routine laboratory tests for antiretroviral drug toxicity are no longer required.

Abstract

These guidelines update the 2013 “Updated US Public Health Service (PHS) Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis,” hereafter referred to as the 2013 PHS Guidelines.
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The availability of new medication options, new information on the window of detection for different human immunodeficiency virus (HIV) tests, and the risk of transmission from people with undetectable viral loads prompted this update. The primary intended audience for these recommendations remains anyone involved in the provision of HIV post-exposure management to healthcare personnel (HCP).

The U.S. Centers for Disease Control and Prevention assembled a working group of representatives from federal agencies in the U.S. Department of Health and Human Services (HHS) who identified the priority topics for update and conducted systematic literature reviews to formulate recommendations (see Appendix). All recommendations were reviewed by the Healthcare Infection Control Practices Advisory Committee (HICPAC) at public meetings, and by a non-consensus forming panel of external experts. New evidence-based recommendations are developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and classified according to the HICPAC recommendation scheme when evidence supported recommendation development.
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Other recommendations in this document are classified as good practice statements according to the criteria set forth by GRADE.
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The working group solicited additional feedback on recommendations from relevant agencies, subject-matter experts, and the public.

Recommendations that have changed since the 2013 PHS guidelines include:new antiretroviral drug regimens for post-exposure prophylaxis (PEP);a shortened duration of post-exposure follow-up HIV testing;elimination of routine laboratory tests for antiretroviral drug toxicity; andconsiderations for PEP for HCP with exposures to source patients with undetectable viral loads.

new antiretroviral drug regimens for post-exposure prophylaxis (PEP);

a shortened duration of post-exposure follow-up HIV testing;

elimination of routine laboratory tests for antiretroviral drug toxicity; and

considerations for PEP for HCP with exposures to source patients with undetectable viral loads.

Important strategies in the principles of exposure management remain: primary prevention strategies; the prompt reporting and management of occupational exposures; adherence to recommended HIV PEP regimens when indicated; the role of expert consultation in management of exposures; and follow-up of exposed HCP.

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