Malicious bites: recoils

Malicious bites: recoils


In recent months, in France as in other European countries, people have been called to the emergency services, screening centers (Cegidd) or forensic units following possible bites of unknown origin. festive or other environment. In a statement (May 2022), the French Society for the Fight against AIDS (SFLS) notes that “the caregivers in charge of counseling around virus exposure accidents have been widely sought in this context. Decisions remain difficult to make in a highly publicized and highly anxious context for consultants ”. The SFLS therefore chose to “recall the post-exposure management recommendations for HIV / HBV / HCV viral risk in case of skin lesions, adapted in case of suspicion of malicious sting of unknown origin”. The learned society has therefore published recommendations which “only apply to cases of suspected isolated malicious sting.” Other situations (loss of consciousness and / or suspicion of sexual assault and / or suspicion of non-consensual sexual intercourse) should be considered with a differentiated risk of viral exposure and benefit from appropriate prophylactic management according to the recommendations in course ”. The recommendations focus on “viral risk and the indication for post-HIV treatment.” The SFLS recalls that “post-HIV treatment is not recommended in France in case of a sting with an abandoned syringe or in case of an accidental sting with an IM needle. [intramusculaire, ndlr]SC [sous-cutané, ndlr] or with a non-hollow needle with a person of unknown status ”. These recommendations take into account: the low prevalence of HIV in France (estimated at 0.4% in adults aged 15 to 49); the fact that almost all (> 90%) of adults known to be living with HIV are on effective antiretroviral therapy without the risk of transmission; the limited number of people living with HIV who are unaware of their infection, estimated at less than 24,000 in 2018; low external HIV survival; due to the fact that no HIV infection was observed after an accidental puncture outside of care. “Given these epidemiological and virological elements, we believe that the very low risk of HIV transmission does not justify the introduction of post-exposure treatment for HIV in this malignant sting situation.” In case of doubt, in an exceptional situation, specialist advice may be given in accordance with the usual procedures of the emergency services, and in the event that such advice cannot be obtained promptly, post-HIV treatment may be initiated in waiting for a reassessment by a specialized unit within 48-72 hours ”. In addition, the initial care will have to focus, among other things, on “conducting a medical examination for a trace of skin break-in in order to assess the risk of infection and to establish a descriptive medical certificate.” »; “Perform a blood sample (viral assessment: HIV, HBV, HCV serology)”. And the SFLS to supplement: HIV, HCV and HBV Viral Risk Monitoring: HIV: Prescribing a TPE Is Not Indicated If Only a Malicious Bite Is
reported (except in exceptional situations). Serological monitoring is recommended at six weeks; HCV: The risk of transmission is low and there is no drug prevention. Serological monitoring is recommended at 12 weeks; HBV: In case of non-immunization HBV (Ac anti HBs <10 mIU / ml), it is recommended to start vaccination within 72 hours at most (maximum 7 days). It is not recommended to administer immunoglobulins in this situation.

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