{"id":24,"date":"2008-06-24T19:57:59","date_gmt":"2008-06-25T00:57:59","guid":{"rendered":"http:\/\/blogs.nejm.org\/pov\/hiv-id-observations\/index.php\/2008\/06\/24\/hiv-occupational-post-exposure-prophylaxis-do-the-right-thing\/"},"modified":"2008-06-24T19:57:59","modified_gmt":"2008-06-25T00:57:59","slug":"hiv-occupational-post-exposure-prophylaxis-do-the-right-thing","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/hiv-occupational-post-exposure-prophylaxis-do-the-right-thing\/2008\/06\/24\/","title":{"rendered":"HIV Occupational Post-exposure Prophylaxis: Do the Right Thing"},"content":{"rendered":"

<\/span>From one of our local HIV providers:<\/font><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n

There were two occasions recently when our local infectious disease doctor was consulted by the emergency room to decide what type of post exposure prophylaxis regimen to recommend for individuals who had sustained an occupational exposure (needlesticks) to two of our HIV positive patients.\u00a0 It had been known to the emergency room physicians that the patients had been HIV-infected and that they were receiving their care here.\u00a0 The ID physician contacted our clinic for information about the patients to come up with the most appropriate preventive regimen.<\/font><\/p>\n

Some here have felt that we could not give information out to the physician to preserve patient confidentiality.<\/font><\/p>\n

But others (including myself) felt strongly that given the CDC recommendations that information should be obtained regarding the source patient’s antiretroviral therapy, the resistance pattern, and the viral load in order to recommend the best regimen for PEP to avoid HIV transmission, it was completely appropriate for the ID physician to try to get more information.<\/font><\/p>\n

I would be curious to know your thoughts on this issue ….<\/font><\/p><\/blockquote>\n

One of the (many) things that has always bugged me about “HIV exceptionalism<\/a>” — where HIV is treated differently from other infectious diseases — is the way it burdens healthcare providers who sustain occupational exposures to blood-borne pathogens.\u00a0\u00a0\u00a0<\/font><\/p>\n

From a medical<\/em> perspective, the answer to the above case is simple:\u00a0 reveal the source patients’ HIV viral load, resistance profile, and current treatment\u00a0to the ID doctor trying to manage the exposed healthcare worker — and go ahead and\u00a0disclose\u00a0hepatitis B and C status while you’re at it.\u00a0 This is the best thing for the unfortunate nurse (or doctor or medical student or phlebotomist or maintenance worker) who is likely now trembling with anxiety over the exposure.\u00a0 Bad enough that they have had the injury; even worse that they would need to be managed in an information vacuum.<\/font><\/p>\n

From an ethical<\/em> perspective, it seems fairly straightforward too.\u00a0 We should do whatever we can, within reason,\u00a0to protect the healthcare worker and prevent HIV transmission.\u00a0 That’s the benefit of revealing source patient information to the clinician trying to craft the best preventive strategy.\u00a0 This outweighs the risk to that patient (the source) for the disclosure, which\u00a0should be minimal — after all, the information is being released to a clinician, who presumably understands the importance of patient confidentiality.<\/font><\/p>\n

And that’s what I emailed back to the doctor who’d contacted me.<\/font><\/p>\n

Ah, but what about the legal issue?\u00a0 She also emailed a respected local lawyer, who wrote:<\/font><\/p>\n

As the lawyer I have to point out that any time a person’s private medical information is disclosed without authorization from the person (the source patient) and for the benefit of another person one is potentially running the risk of violating several federal and\/or state privacy and confidentiality laws.\u00a0 <\/font><\/p><\/blockquote>\n

Uh-oh.\u00a0 Could someone possibly<\/em> argue not to give out the information?\u00a0 What if the person exposed contracted HIV due to the wrong preventive therapy being prescribed?\u00a0<\/font><\/p>\n

Fear not, there’s more:<\/font><\/p>\n

With all that said, these are clearly difficult medical\/ethical\/legal issues. At times, where the risk of harm caused by the disclosure\/breach of privacy or confidentiality of the source patient is extremely low and the potential benefit to another patient is great, potential liability may be trumped by medical\/ethical decision making. And, hopefully even the most strident protector of patient privacy\/confidentiality would agree that it was the right thing to do.\u00a0\u00a0\u00a0\u00a0 <\/font><\/p><\/blockquote>\n

Great, so we’re in agreement after all.\u00a0 <\/font><\/p>\n

Do the right thing.<\/font><\/p>\n

<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

From one of our local HIV providers: There were two occasions recently when our local infectious disease doctor was consulted by the emergency room to decide what type of post exposure prophylaxis regimen to recommend for individuals who had sustained an occupational exposure (needlesticks) to two of our HIV positive patients.\u00a0 It had been known […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5,9],"tags":[],"class_list":["post-24","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","category-policy"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/24","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=24"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/24\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=24"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=24"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=24"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}