Introduction Post-exposure prophylaxis (PEP) reduces the risk of transmission of human immunodeficiency virus (HIV) following blood exposure accidents (BEA). However, there are no updated Tunisian recommendations for its use.

Objectives To describe the circumstances of BEA requiring PEP and to evaluate the prescribing practices of PEP and clinical, biological and serological follow-up of victims.

Methods We conducted a descriptive retrospective study of victims of BEA who sought medical care in the occupational medicine department of Rabta hospital in Tunis, from 1998 to 2018 and for whom a PEP was prescribed.

Results A total of 456 cases were included with a median age of 30±10.3 years and a sex-ratio of 0.56. They were healthcare workers in 98% of cases, mainly physicians (35.4%), hospital porters and cleaning staff (22.3%). The most frequent tasks leading to the accidents were waste disposal (16%) and taking blood samples (10.8%). In cases of known sources (72.6%), the PEP was prescribed because the sources were HIV positive (23.6%) or had risk factors for HIV infection, mainly scarifications and/or tattoos (23.1%), drug abuse (12.9%) or history of hepatitis B and/or C (12%). In cases of unknown sources, PEP was prescribed if the BEA occurred in a suspicious socio-epidemiological context. The PEP was started within four hours of the BEA in 42.8% of cases and covered 28 days in 56.8% of cases. Poor compliance with PEP was noted in 55% of cases. The serological follow-up at one, three and six months was carried out in 11.6%, 6.5% and 4.5% of cases, respectively. Positive HIV serology of the source was significantly associated with compliance to serological follow-up at one month (p=0.023) and at three months (p=0.029). None of the cases had a seroconversion.

Conclusion A well-managed PEP prevents the risk of HIV seroconversion following a BEA. It is crucial to develop a national updated guideline for management of BEA and PEP.