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Case 5: Nonoccupational Exposure to HIV

You answered:

C The 2005 DHHS guidelines for antiviral PEP after sexual exposure to HIV recommend less aggressive antiretroviral regimens than those used for occupational PEP exposure, because all sexual exposures carry a markedly lower risk of HIV transmission than do percutaneous exposures to HIV.

This answer is incorrect. With a known HIV-infected source patient, some sexual exposures, such as unprotected receptive anal intercourse, have an estimated risk of HIV transmission that equals or exceeds the estimated risk with an occupational needlestick injury.

A Antiviral PEP should not be recommended in this case because the source patient recently had an HIV RNA level less than 50 copies/ml.
B Nevirapine (Viramune) should not be used as part of an antiviral PEP regimen after sexual exposure to HIV.
D Studies have shown that offering PEP in this setting will lead to an increase in unsafe sexual behavior.

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