2025 Updates to Guidelines for Occupational HIV Exposure for Healthcare Personnel

The Centers for Disease Control and Prevention has released an updated version of the Guidelines for the Management of Occupational Exposure to Human Immunodeficiency Virus (HIV) and Recommendations for Postexposure Prophylaxis (PEP), on behalf of the U.S. Public Health Service (PHS), according to a news release. The guidelines were published in Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

The PHS Guidelines were last updated in 2013. This most recent version includes the elimination or reduction of certain routine testing and considerations for healthcare personnel taking preexposure prophylaxis (PrEP) or exposed to an HIV patient with an undetectable viral load.

Recommendations have changed due to scientific advancements. The FDA has approved several new, more effective, and more convenient antiretrovirals since 2013. For example, the 2025 FDA approval of lenacapavir as a twice-yearly PrEP injection.

Additionally, data has come out demonstrating the effectiveness of HIV tests and the low risk of transmission from patients with undetectable viral loads.

Additional research has also come out stating that the average risk for HIV transmission after a percutaneous exposure to HIV-infected blood has been estimated to be 0.23%, according to the guidelines. Infection risk after mucous membrane exposure is even lower at 0.09%.

“These updated guidelines reflect the latest evidence and therapeutic advances, helping ensure that healthcare personnel receive timely, safe and effective care after potential HIV exposure,” David J. Weber, M.D., M.P.H., Society for Healthcare Epidemiology of America Board of Trustees president and associate editor of Infection Control and Hospital Epidemiology, said in the news release. “They also recognize the changing landscape of HIV prevention, including the increasing use of PrEP among healthcare providers.”

Listed below are some of the biggest guideline changes.

When treating HIV patients with undetectable viral loads, or if healthcare personnel are already on PrEP

Updated guidelines recommend that the exposed healthcare personnel be included in the decision of whether to begin PEP.

Previous guidelines only recommended that the exposed worker consult a provider with HIV treatment expertise.

Laboratory Protocols Have Been Shortened

The updated guidelines only recommend that exposed healthcare personnel who have received cabotegravir-based PrEP in the past 12 months receive additional HIV testing, in consultation with a provider with expertise in HIV treatment. This is because cabotegravir is long-acting and may delay the detection of HIV antibodies for months.

Interim HIV testing should be done every 4 to 6 weeks only for exposed healthcare personnel who initiated PrEP 24 hours previously or who have missed any PEP doses, both of which would put them at an increased risk of breakthrough HIV infection.

The final HIV tests of exposed healthcare personnel using lab-based HIV Ag/Ab combination immunoassay and nucleic acid testing should happen no later than 12 weeks post-exposure. Almost all (99%) of HIV-infected individuals would be detectable within 44 days of exposure.

Follow-up testing is only recommended when baseline tests are abnormal or there are clinical indications.

Previous recommendations stated that all exposed healthcare personnel receive testing as soon as possible. Additional testing was recommended on a case-by-case basis, based on healthcare personnel clinical situation or other medical comorbidities. For example, if they had an illness compatible with an acute retroviral syndrome.