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Post-exposure prophylaxis (PEP) can be a secondary measure to prevent infection by human immunodeficiency virus (HIV) when primary prevention has failed. PEP is advised for people with sporadic and exceptional risk exposure to HIV. This consensus document about occupational and non-occupational PEP recommendations aims to be a technical document for healthcare professionals. Its main objective is to facilitate the appropriate use of PEP. To this end, some recommendations have been established to assess the risk of transmission in different types of exposure, situations where PEP should be recommended, special circumstances to take into account, antiretroviral (ARV) guidelines including start and end of the treatment, early monitoring of tolerance and adherence to the treatment, subsequent monitoring of people exposed, independently of having received PEP or not, and need of psychological support. This document is intended for all professionals who work in clinical practice in the field of HIV infection.

Introduccion y objetivo La inmigracion a nuestro pais de poblaciones latinoamericanas afectadas de enfermedad de Chagas en fase indeterminada abre la posibilidad de transmision vertical y por transfusion o trasplante de organos afectados por esta enfermedad. Para averiguar la magnitud del problema, hemos investigado la prevalencia de portadoras entre las mujeres que dan a luz en tres maternidades publicas de la Comunidad Valenciana y la tasa de transmision vertical. Pacientes y metodos A un total de 624 mujeres latinoamericanas embarazadas se les practico una prueba de inmunoprecipitacion para detectar anticuerpos anti- Trypanosoma cruzi . A las madres positivas se les realizo inmunofluorescencia indirecta y reaccion en cadena de la polimerasa (PCR), y a sus hijos, microhematocrito y PCR en el periodo neonatal e inmunoprecipitacion a partir de los 7 meses de vida. Se remitieron las madres seropositivas a la consulta de medicina interna. Se calculo el porcentaje de serologia positiva total y por paises. Resultados Un total de 29 mujeres (4,8 %; intervalo de confianza [IC] del 95 %: 3,1-6,3) eran seropositivas, todas asintomaticas y con PCR negativa. Ninguno de sus hijos resulto positivo en las pruebas realizadas. Las mujeres bolivianas fueron las mas frecuentemente afectadas: 24 de 137 (17,5 %; IC 95 %: 11,2 a 23,9). Discusion La elevada prevalencia de enfermedad de Chagas en la poblacion inmigrante latinoamericana obliga a sensibilizar a los profesionales implicados en el conocimiento de esta enfermedad. Se necesitan mas estudios epidemiologicos para poder establecer la conveniencia de programas de deteccion universal para este colectivo.

Immigration to Spain of Latin Americans with Chagas disease in its indeterminate phase could result in vertical transmission of the disease or transmission by transfusion or organ transplantation. To ascertain the magnitude of this problem, we investigated the prevalence of bearers among women who gave birth in 3 state maternity hospitals in the Valencian Community and the incidence of vertical transmission.An immunoprecipitation test to detect anti-Trypanosoma cruzi antibodies was carried out on 624 pregnant Latin American women. In positive cases, indirect immunofluorescence and PCR analysis were performed on mothers. In addition, a microhematocrit and PCR analysis were performed on the newborns of these mothers, and immune precipitation was carried out from age 7 months. Chagas-positive mothers were referred for outpatient care at the hospital internal medicine departments. Percentage of positive serology was calculated for the total number of patients and by country of origin.A total of 29 women (4.8%; 95% CI, 3.1-6.3) were Chagas-positive; all were asymptomatic and PCR-negative. None of their children were positive to the tests performed. Bolivian women were the most frequently affected: 24 out of 137 (17.5%; 95% CI, 11.2-23.9)The high prevalence of Chagas disease in the Latin American immigrant population has raised awareness of this disease among professionals involved in the study and treatment of this illness. Further epidemiological studies are needed to establish the feasibility of universal detection programs in this population.