Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the Centers for Disease Control and Prevention.

Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Post-exposure Prophylaxis in Healthcare Settings

Centers for Disease Control and Prevention

Publication Date: Sep 16, 2025

Page Last Updated: May 6, 2026

Management of HCP with an occupational exposure to HIV

Educate HCP to report occupational exposures to blood and body fluids as soon as possible to their occupational health service. Good Practice Statement, Existing Recommendation
Initiate PEP as soon as possible, up to 72 hours following the occupational exposure to HIV. Good Practice Statement, Existing Recommendation
When considering initiation of PEP after 72 hours following occupational exposures thought to represent a high risk of transmission, consult a provider with expertise in HIV treatment* (see Box 1). Good Practice Statement, Existing Recommendation
Prescribe PEP regimens for a duration of 28 days. Good Practice Statement, Existing Recommendation
Determine the HIV status of the source patient whenever possible to guide appropriate use of PEP. Good Practice Statement, Existing Recommendation
Do not delay administration of PEP while waiting for information regarding the source patient’s HIV status. Good Practice Statement, Existing Recommendation
Discontinue PEP and HIV follow-up testing if the source patient is determined to be HIV negative. Good Practice Statement, Existing Recommendation
Provide counseling to exposed HCP in accordance with CDC recommendations for HCP with occupational exposures 15 , and including the:
- Importance of adherence to PEP;
- Use of precautions (i.e., use of barrier contraception, avoidance of blood or tissue donations) to prevent secondary transmission until the final HIV test post-exposure (see Laboratory Testing of Exposed HCP);
- Drugs 16 that should not be taken with PEP or require dose or administration adjustments, side effects of prescribed PEP, and measures (including pharmacologic interventions) that may assist in minimizing side effects; and
- Importance of clinical evaluation if any acute symptoms (i.e., side effects of prescribed PEP, symptoms of acute HIV) develop prior to the final HIV test post-exposure (see Laboratory Testing of Exposed HCP).
- Good Practice Statement, Existing Recommendation
Re-evaluate exposed HCP within 72 hours after occupational exposure to assess for further counseling needs and PEP tolerability. Good Practice Statement, Existing Recommendation
Consult a provider with expertise in HIV treatment* for HCP unable to take the initial PEP regimen due to intolerance or toxicity (see Box 1). Good Practice Statement, Existing Recommendation
Refer HCP determined to have HIV infection to a provider with expertise in HIV treatment*. Good Practice Statement, Existing Recommendation

Document Overview

Document Title: Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Post-exposure Prophylaxis in Healthcare Settings

Authoring Society: Centers for Disease Control and Prevention

Document Publication Date: Sep 16, 2025

Page Last Reviewed/Updated: May 6, 2026

Document Type: Consensus Statement

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/2025-us-public-health-service-guidelines-for-the-management-of-occupational-exposures-to-human-immunodeficiency-virus-and-recommendations-for-postexposure-prophylaxis-in-healthcare-settings/A410E90C8C13C8B9FB417C7F42051D2A

Source Citation: Kofman, Aaron D et al. “2025 US Public Health Service Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Post-exposure Prophylaxis in Healthcare Settings.” Infection control and hospital epidemiology vol. 46,9 (2025): 863-873. doi:10.1017/ice.2025.10254

Supplemental Implementation Resources

Table 2. Initial Preferred and Alternative Human Immunodeficiency Virus (HIV) Post-exposure Prophylaxis (PEP) Regimens for Healthcare Personnel

Document Scope, Criteria, and Use Cases

Document Objectives: These guidelines update the 2013 "Updated US Public Health Service (PHS) Guidelines for the Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Postexposure Prophylaxis," hereafter referred to as the 2013 PHS Guidelines., The availability of new medication options, new information on the window of detection for different human immunodeficiency virus (HIV) tests, and the risk of transmission from people with undetectable viral loads prompted this update. The primary intended audience for these recommendations remains anyone involved in the provision of HIV post-exposure management to healthcare personnel (HCP).The U.S. Centers for Disease Control and Prevention assembled a working group of representatives from federal agencies in the U.S. Department of Health and Human Services (HHS) who identified the priority topics for update and conducted systematic literature reviews to formulate recommendations (see Appendix). All recommendations were reviewed by the Healthcare Infection Control Practices Advisory Committee (HICPAC) at public meetings, and by a non-consensus forming panel of external experts. New evidence-based recommendations are developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and classified according to the HICPAC recommendation scheme when evidence supported recommendation development., Other recommendations in this document are classified as good practice statements according to the criteria set forth by GRADE. The working group solicited additional feedback on recommendations from relevant agencies, subject-matter experts, and the public. Recommendations that have changed since the 2013 PHS guidelines include: • new antiretroviral drug regimens for post-exposure prophylaxis (PEP); • a shortened duration of post-exposure follow-up HIV testing; • elimination of routine laboratory tests for antiretroviral drug toxicity; and • considerations for PEP for HCP with exposures to source patients with undetectable viral loads. Important strategies in the principles of exposure management remain: primary prevention strategies; the prompt reporting and management of occupational exposures; adherence to recommended HIV PEP regimens when indicated; the role of expert consultation in management of exposures; and follow-up of exposed HCP.

Scope: Management, Prevention

Diseases/Conditions (MeSH)

D054298 - Human Immunodeficiency Virus Proteins

D056990 - Post-Exposure Prophylaxis

D054298 - Human Immunodeficiency Virus Proteins

D056990 - Post-Exposure Prophylaxis

Keywords: HIV infections, Human Immunodeficiency Virus, Occupational Exposures, Post-exposure Prophylaxis

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Hospital, Outpatient

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Management of Occupational Exposures to Human Immunodeficiency Virus and Recommendations for Post-exposure Prophylaxis in Healthcare Settings

Summary of Recommendations

Management of HCP with an occupational exposure to HIV

Management of pregnant or breastfeeding HCP with an occupational exposure to HIV

Selection of agents for HIV PEP

Table 2. Initial Preferred and Alternative Human Immunodeficiency Virus (HIV) Post-exposure Prophylaxis (PEP) Regimens for Healthcare Personnel

Management of occupational exposures to source patients with HIV and undetectable serum viral loads

Management of occupational exposures in HCP on pre-exposure prophylaxis for HIV

Management of occupational exposures to an unknown source (e.g., needle in sharps disposal container)

Management of occupational exposures to source patients with drug-resistant HIV

Laboratory testing of exposed HCP

Box 1. Resources for expert consultation for Human Immunodeficiency Virus (HIV) Post-exposure Prophylaxis (PEP)

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases