12
Management
HCP Living with HIV
➤ HCP living with HIV should seek an initial evaluation from a physician
who has expertise in HIV management to characterize the serologic,
virologic, and immunologic aspects of infection.
➤ HCP living with HIV should seek optimal medical management,
including treatment with effective combination antiretroviral agents
to suppress viral replication.
➤ HCP living with HIV who do not perform Category III/exposure-prone
procedures should not be prohibited from participating in patient-
care activities solely on the basis of their HIV infection.
➤ Consonant with the most recent set of guidelines from the CDC, there
is no justification for, nor benefit gained from, routine notification of
patients with regard to HCP living with HIV who are being managed
with the guidance of an oversight panel.
➤ For HCP living with HIV who perform Category III/exposure-prone
procedures,
a. HCP living with HIV and who, despite appropriate antiretroviral treatment,
have a confirmed viral load >200 copies/mL should not perform Category III/
exposure-prone procedures until they have achieved virologic suppression.
b. HCP living with HIV whose confirmed viral load is below 200 copies/mL can
perform Category III/exposure-prone procedures, so long as the HCP:
i. has not been previously identified as having transmitted infection to
patients while receiving appropriate suppressive therapy
ii. obtains advice from an oversight panel (discussed in more detail below)
about recommended practices to minimize risk of exposure events
iii. is followed by a physician who has expertise in the management of
HIV infection and who is allowed by the individual to participate in or
communicate with the oversight panel about the individual's clinical status
iv. is monitored on a periodic basis (e.g., every 6 months) to assure that the
HIV-RNA remains below the level of detection, with results provided to
the oversight panel
v. is followed closely by their physician and the oversight panel. In instances in
which fluctuations in HIV viremia occur, including appropriate retesting as
discussed above to reevaluate the HCP's viral load and
vi. agrees, in writing, to follow the recommendations of the oversight panel.
