Treatment

592 Decision to treat will be made by an experienced medical staff member. Treatment recommended for 'all health care workers exposed to high risk body fluids or tissues known to be, or strongly suspected to be, infected with HIV through percutaneous exposure, mucous membrane exposure or through exposure of broken skin.' Zidovudine alone given as soon as possible 5 risk of seroconversion by 80% but failures are well described. Prophylaxis with triple therapy now recommended. Treat for 4 wks as soon as possible with:

• Zidovudine 200mg tds/250mg bd + Lamivudine 150mg bd + Indinavir 800mg tds. A 'starter pack' should be available in an accessible place at all times.

• Known exposure to hepatitis B

- No immunity—give HepB Ig 500mg IM; vaccinate immediately.

- Known immunity with HepB Ab >100 IU/L in past 2 yr—no action.

- Immunity—HepB Ab status not known—give booster dose.

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