Since raltegravir is generally well tolerated and has now been approved by the US Food and Drug Administration for treatment-naive patients, it represents a potential alternative to protease inhibitors for use in expanded regimens. However, there are only limited data on its safety in healthy uninfected individuals. The choice of regimen should take into consideration the most common ART regimens being used in the country where the trainee is rotating. Furthermore, if the source

is found to be HIV positive with a history of ART, further guidance will be required to assess documented or suspected viral resistance and adjust the regimen accordingly as the patient might have a drug-resistant virus strain. In more complex cases such as those involving pregnancy, breast-feeding, or exposure to a source patient with documented poor ART adherence, an infectious disease specialist should be consulted find more to help decide the most appropriate regimen. However, in the absence of immediate access to a specialist or an alternative PEP regimen, the standard PEP

protocol should http://www.selleckchem.com/products/GDC-0980-RG7422.html be followed until the specialist makes alternative recommendations or access to more appropriate ART becomes possible. With the rapid rise of interest in global health and increasing numbers of health care trainees participating in international electives, the medical community has an obligation to develop provisions to adequately support and protect them. Medical trainees are at considerable risk for contracting HIV, and in the event of an occupationally acquired infection, the consequences can be devastating for both the trainee and their home institution. As an infected health care professional, these trainees

may potentially face difficulties securing health insurance, possible problems resulting in loss of income, and as their illness progresses, long-term disability and premature death. Given their tenuous status, students may not be eligible for workers’ compensation and private insurance, leaving them vulnerable to considerable financial difficulties with a debilitating illness. As most students did not receive compensation Y-27632 2HCl for their contributions, they do not fall under the purview of workers’ compensation laws, unless the law specifies the coverage of apprentices. Trainees, left with no other options, may be compelled to pursue legal action, leaving medical schools and teaching hospitals at risk for civil litigation.22 Ultimately, academic institutions have a commitment to educate, guide, and protect their students and residents. Thus, pre- and postdeparture travel clinic visits, immunizations, PEP starter pack, and 24-hour access to a home-based clinician with appropriate expertise should be made available by the institutions themselves.