{
  "id": "medical/needle-stick-hiv-pep-delay",
  "signature": "AI advises a healthcare worker after needle-stick injury to 'wait for the source patient's HIV test result' before starting PEP",
  "signature_zh": "AI建议医护人员在针刺伤后'等待源患者HIV检测结果'再开始PEP",
  "regex": "(?i)(needle.?stick|sharps|needlestick|occupational exposure).*(wait|delay|hold|pending).*(HIV|result|test).*(PEP|prophylaxis|antiretroviral)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Post-exposure prophylaxis (PEP) for HIV must be started within 72 hours of exposure, ideally within 4 hours. Delaying PEP to wait for source patient test results—especially if the source is high-risk (e.g., IV drug user, unknown status)—wastes critical time. CDC guidelines recommend starting empiric PEP immediately if source is high-risk or status unknown, and stopping only if source tests negative.",
  "root_cause_type": "generic",
  "root_cause_zh": "HIV暴露后预防（PEP）必须在暴露后72小时内开始，最好在4小时内。等待源患者检测结果而延迟PEP——尤其是源患者为高风险（如静脉吸毒者、状态不明）——会浪费关键时间。CDC指南建议若源患者高风险或状态不明，立即开始经验性PEP，仅在源患者检测阴性后停用。",
  "versions": [],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "Recommending to wait for source patient's rapid HIV test (e.g., fingerstick) before starting PEP",
      "why_fails": "Rapid tests have a window period (up to 3 months for some); a negative rapid test does not rule out acute HIV infection. PEP should start immediately if source is high-risk.",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    },
    {
      "action": "Telling HCW to 'just wash the wound and monitor for symptoms'",
      "why_fails": "Symptoms of acute HIV infection appear 2-4 weeks post-exposure; waiting for symptoms loses the window for PEP entirely. PEP is only effective if started before seroconversion.",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    },
    {
      "action": "Suggesting that PEP is only needed if the source patient is known to be HIV-positive",
      "why_fails": "Many source patients are unaware of their status; up to 40% of occupational HIV exposures are from unknown-status sources. Empiric PEP is standard in these cases.",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Immediately after needle-stick injury: wash wound with soap and water (don't scrub), flush mucous membranes with water. Go to occupational health or ED within 4 hours. Start empiric PEP (e.g., tenofovir disoproxil fumarate 300 mg + emtricitabine 200 mg once daily, plus raltegravir 400 mg twice daily or dolutegravir 50 mg once daily) if source is high-risk or unknown. Obtain source patient's consent for HIV testing, but do not delay PEP. If source tests negative (with fourth-generation antigen/antibody test), PEP can be stopped.",
      "success_rate": 0.9,
      "how": "Immediately after needle-stick injury: wash wound with soap and water (don't scrub), flush mucous membranes with water. Go to occupational health or ED within 4 hours. Start empiric PEP (e.g., tenofovir disoproxil fumarate 300 mg + emtricitabine 200 mg once daily, plus raltegravir 400 mg twice daily or dolutegravir 50 mg once daily) if source is high-risk or unknown. Obtain source patient's consent for HIV testing, but do not delay PEP. If source tests negative (with fourth-generation antigen/antibody test), PEP can be stopped.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If source patient is unavailable or refuses testing, continue full 28-day PEP course. Offer HCW baseline HIV test, then follow-up testing at 6 weeks, 12 weeks, and 6 months post-exposure.",
      "success_rate": 0.85,
      "how": "If source patient is unavailable or refuses testing, continue full 28-day PEP course. Offer HCW baseline HIV test, then follow-up testing at 6 weeks, 12 weeks, and 6 months post-exposure.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Immediately after needle-stick injury: wash wound with soap and water (don't scrub), flush mucous membranes with water. Go to occupational health or ED within 4 hours. Start empiric PEP (e.g., tenofovir disoproxil fumarate 300 mg + emtricitabine 200 mg once daily, plus raltegravir 400 mg twice daily or dolutegravir 50 mg once daily) if source is high-risk or unknown. Obtain source patient's consent for HIV testing, but do not delay PEP. If source tests negative (with fourth-generation antigen/antibody test), PEP can be stopped.",
    "If source patient is unavailable or refuses testing, continue full 28-day PEP course. Offer HCW baseline HIV test, then follow-up testing at 6 weeks, 12 weeks, and 6 months post-exposure."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.cdc.gov/hiv/guidelines/preventing-occupational-exposures.html",
  "official_doc_section": null,
  "error_code": "CDC-2023-PEP",
  "verification_tier": "ai_generated",
  "confidence": 0.87,
  "fix_success_rate": 0.83,
  "resolvable": "true",
  "first_seen": "2024-11-05",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}