In the wake of recent breakthroughs in antiviral therapies and Centers
for Disease Control and Prevention (CDC) recommendations advocating occupational
postexposure prophylaxis (PEP), health care workers are increasingly receiving
inquiries about PEP following exposures to the human immunodeficiency virus
(HIV) through sex and injection drug use. The probability of HIV transmission
by certain sexual or injection drug exposures is of the same order of magnitude
as percutaneous occupational exposures for which the CDC recommends PEP. In
such cases, if the exposure is sporadic, it seems appropriate to extrapolate
from the data on occupational PEP and recommend prophylaxis. However, for
individuals with continuing or low-risk exposures, we instead recommend referrals
to state-of-the-art risk reduction programs. Clinicians, using local HIV seroprevalence
data and their knowledge of transmission probabilities, can help exposed patients
make an informed decision regarding PEP. Because of the large number of risky
encounters that will not be treated prophylactically, even after significant
outreach efforts, public health interventions that emphasize PEP as part of
a comprehensive HIV prevention program should be confined to cities with highest
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