Breastfeeding and pregnancy are not contraindications for the use of post-exposure prophylaxis for HIV,21 and women who are breastfeeding or pregnant should receive post-exposure prophylaxis if it is indicated. There is a significant risk of in utero transmission of HIV and transmission of HIV through breastfeeding and although the data is limited, it does not appear that the use of post-exposure prophylactic drugs increases the number of birth defects or is harmful to breastfeeding infants.21 Efavirenz (Sustiva™) is teratogenic and should not be used in pregnant women.8 Current information about the use of antiviral drugs during pregnancy can be found on the website of the Antiviral Pregnancy Registry, www.apregistry.com. Informationcan also be obtained by calling the National Perinatal HIV Hotline, 7 days a week, 24 hours a day,1-888-448-8765.
Exposure to, and subsequent infection with drug-resistant strains of HIV has been reported to occur after occupational exposure to HIV, despite early use of post-exposure prophylaxis. It is not practical to perform drug-resistance testing immediately after exposure to HIV, therefore standard post-exposure prophylaxis should be initiated as soon as possible.
Treatment should not be delayed while waiting for drug-resistance testing.21 If there is a possibility that the source patient may be infected with a drug-resistant strain of HIV, expert consultation should be sought and without delay; post-exposure prophylaxis should be started right away.21 The drug regimen can be changed later if this is needed
Exposure to a needle or a sharp from an unknown source should not occur with good adherence to the blood-borne pathogens standards. If an exposure of this type occurs the need for post-exposure prophylaxis should be determined on a case-by-case basis. 21