NVP should be avoided due to concerns about hepatoxicity. This drug also causes high rates of rash and occasional cases of Stevens-Johnson syndrome. EFV causes CNS toxicity and possible teratogenic effects in pregnancy. Anticipated or proven resistance in the source strain may influence decisions regarding agent selection in the health care worker. The obvious problem is the time required for test results and the importance of rapid institution of prophylaxis.
Most authorities recommend that decisions be based on the drug history and viral load of the source.
It was felt that performing surgery in anatomical sites that could not be visualized would be most likely to result in injuries, with the potential for patient exposure to provider blood. The probable outcome was that HIV-infected physicians would be forced to abandon surgical careers or be required to explain risks to potential surgical patients. This means that a patient exposed to blood from an HIV-infected surgeon, such as an accidental needle injury resulting in contamination of the surgical field with the surgeon's blood, needs counseling regarding the exposure and the option of antiretroviral treatment. The Johns Hopkins University on behalf of its Division of Infectious Diseases and AIDS Service. All rights reserved.