If the source patient is found to MAPK Inhibitor Library be HIV negative, PEP can be discontinued. If the source is known to be HIV positive, the event is assessed to determine the degree of exposure according to standard Centers for Disease Control (CDC) guidelines.8 With a low-risk exposure,
a basic two-drug PEP regimen is initiated. With a high-risk exposure, lopinavir/ritonavir is added to the basic regimen. Residents and students with an exposure are required to undergo both follow-up testing at predetermined intervals and postexposure counseling. A survey of medical schools in the UK found that 91% (20 of 22) had provided information on occupational exposure to HIV to their students, but only 2 (9%) had PEP available for students on overseas electives.14 The few schools that have reviewed their experiences provide useful information on the challenges associated with HIV PEP for traveling medical trainees. For example, at Dundee University in the UK, medical students attend a seminar and are offered free starter packs of ART prior to their international rotations.15 Of the 140 students who went abroad in 1 year, only 22 (16%) carried starter packs of zidovudine
with them. A survey conducted by Dundee University found that 74% (76 of 103) of medical students indicated they had participated in exposure-prone procedures such as surgery or phlebotomy including 38 who had significant exposures, ie, percutaneous, mucous membrane, and nonintact skin contamination. However, only six students considered taking PEP, and ultimately Panobinostat none of the students used PEP. At Guy’s, King’s College, and St Thomas’s School of Medicine in London, medical students are encouraged to pursue electives abroad.16 Students Amino acid have access to clinical advisors who offer academic advice and information on international clinical electives. In addition, students receive a regularly updated policy on avoiding blood-borne pathogens, minimizing risk, postexposure advice, and access to a consultant virologist. Students traveling to areas with a high HIV prevalence are prohibited from participating in high-risk activities (eg, obstetric/gynecology, surgery) and are offered
a 6-day starter pack of zidovudine as monotherapy for 40 pounds (∼US$ 80). Overall, 44% (65 of 148) of students visited areas with moderate to high HIV prevalence. Twenty-seven of these students were unaware of the HIV risk. Of the remaining 38 students, only 25 (66%) had been directly advised on the potential risk of blood-borne pathogens, 13 (34%) carried a PEP starter pack, 24 (63%) purchased a medi-kit, and 20 (53%) took latex gloves with them. Students who were unaware of the HIV prevalence in the areas they visited were less likely to have discussed exposure risk or traveled with a starter pack, a medi-kit, or latex gloves. These institutions have taken the lead in providing for their students and have made strides in developing a system for educating students.
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