Postexpositionelle Prophylaxe der HIV-Infektion

Einleitung

Angesichts der Übertragbarkeit einer HIV-Infektion mit hoher Morbidität und Mortalität wurde international seit 1989 bei Gefahr einer Infektion im beruflichen Alltag die postexpositionelle Einnahme von Zidovudin empfohlen und vielfach praktiziert [1]. Inzwischen liegen deutliche Hinweise auf eine Wirksamkeit dieser Prophylaxe nach beruflicher Exposition vor [2]. Insbesondere zur Vermeidung der vertikalen Übertragung einer HIV-Infektion konnte die Wirksamkeit prä- und postexpositioneller medikamentöser Prophylaxe überzeugend nachgewiesen werden [3].

Im Rahmen eines Konsensusprozesses wurden die zuvor im September 2004 letztmals aktualisierten Empfehlungen im Mai 2007 erneut dem aktuellen Wissensstand und den heute möglichen, veränderten therapeutischen Optionen angepasst. Ziel der Empfehlungen ist es, auf der Grundlage des erweiterten Wissenstandes und der veränderten Therapieoptionen konkrete Handlungsanleitungen zu geben und alle in die Entscheidungen einbezogenen Ärztinnen und Ärzte in die Lage zu versetzen, die Indikation zu einer HIV-Postexpositionsprophylaxe zu stellen, diese durchzuführen und die betroffenen Personen kompetent zu beraten.

Die Möglichkeit einer Postexpositionsprophylaxe muss Bestandteil des ärztlichen Aufklärungsgesprächs bei Menschen mit HIV-Infektion sein und auch in der Bevölkerung im Rahmen der Infektionsprävention breiter bekannt gemacht werden. Für die Aus- und Weiterbildung in Gesundheitsberufen ist sie unverzichtbarer Bestandteil der kontinuierlichen Bemühungen um Infektionsvermeidung bei Arbeitsunfällen.

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1 Haut- und Schleimhautantiseptika werden in der Regel nicht auf Wirksamkeit gegen Viren geprüft. Häufig besitzen Hautantiseptika aber zugleich auch die Indikation „hygienische Händedesinfektion”, für die präparateabhängig auch die Wirksamkeit gegen Viren auf der Basis der gleichen Prüfmethode (Suspensionsversuche) überprüft wird.

2 Siehe „Prüfung und Deklaration der Wirksamkeit von Desinfektionsmitteln gegen Viren”, Stellungnahme der Arbeitskreises „Viruzidie” beim RKI, 2004 Bundesgesundheitsblatt 47: 62-66