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PrEP/PEP

  • 1.  PrEP/PEP

    Posted 04-09-2020 12:03
    Good Morning fellow warriors!  
    A surgery colleague wrote to me this week: planned surgery on a patient with an elevated viral load: the surgeon wants to go on PrEP (as does her surgery first assist) before the operation: kind of a combined PrEP/occupational PEP combo.  She is quite thoughtful and insistent about this.  Thoughts from the group?  Mark Goodman

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    Mark Goodman
    Omaha NE
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  • 2.  RE: PrEP/PEP

    Posted 04-09-2020 23:06
    Hey, Mark!

    Wow, many surgeons have asked me if they should cancel a scheduled surgery but don't think any have asked to do a PrEP / PEP hybrid. Do you know what kind of surgery is being done? How many hours, how much anticipated blood loss? Does the surgeon really understand universal precautions, born out of the HIV/AIDS epidemic? Meaning we learned to treat everyone as if they had an infectious disease.  
    Do you know how elevated the viral load is...1,000....100? An elevated VL doesn't necessarily correlate to transmission. 

    I don't want to insult a colleague and perhaps someone you know well, but I'm not willing to endorse this and don't think this is a good idea or necessary.
    Tell his first assist. don't stick him : )
    That's my 2 cents.

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    Michelle Ogle
    Bronx NY
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  • 3.  RE: PrEP/PEP

    Posted 04-10-2020 10:39
    ​Thanks Doc,
    I hear you, and completely agree with basic foundational Universal precaution truths: but I am also responding to underlying anxiety in  my surgery colleagues.  I also got word that we have colleagues who are "opting out" of surgery and first assist opportunities in these situations; which is a whole additional discussion, right?  I appreciate your thoughts, and will look forward to additional ideas from our team members: many thanks, Mark Goodman

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    Mark Goodman
    Omaha NE
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  • 4.  RE: PrEP/PEP

    Posted 04-11-2020 01:50
    Thanks, Mark-
    Yeah, "opting out" of surgery and assists is a whole new discussion....this is 2020, right? : )
    Look forward to seeing you soon. 

    enjoyed the chat,

    Michelle

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    Michelle Ogle
    Bronx NY
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  • 5.  RE: PrEP/PEP

    Posted 04-11-2020 10:00
    Edited by Gal Mayer 04-11-2020 10:00
    I'm curious. Why not just take PEP if something happens?

    Since the advent of occupational PEP transmission to health care workers is vanishingly rare. The CDC reports that since 1999, there has only been one confirmed transmission to a healthcare worker. (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6353a4.htm)

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    Gal Mayer, MD
    Brooklyn NY
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  • 6.  RE: PrEP/PEP

    Posted 04-11-2020 10:33
    I agree with Michelle, there's no good rationale for going on PrEP prior to the surgery when we practice universal precautions.  The only way the doctor or first assist would be exposed is if they stuck themselves, which I assume would be extremely unlikely, and then they would go on PEP.  Although they may be anxious about their patient having HIV, anxiety/fear is not a good reason to take medication that is not indicated.  I would direct back to the indications for PrEP and remind them how HIV is transmitted (ie, should not happen in their situation).  Good luck!

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    Aliza Norwood
    Austin TX
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  • 7.  RE: PrEP/PEP

    Posted 04-12-2020 07:46
    I am wondering why the surgeon is concerned. Is the possibility of them causing a break in sterile technique that great in this surgery? I was not aware that this could be an issue in a surgery - thought it was a rare occurrence. Also, I have generally found that the danger and lack of complying with standard precautions by healthcare personnel is more an issue when they DON"T know the patient has HIV or has not yet been diagnosed.