Post-exposure Prophylaxis

PEP

Recommendations for PEP

Post-exposure prophylaxis is recommended in case of:

Risk Nature of exposure Status of source person
Blood Subcutaneous or intramuscular penetration
with iv or im needle, or intravascular device
HIV-positive or recent serostatus unknown but presence of HIV risk factors
Percutaneous injury with sharp instrument (lancet), im or sc needle, suture needle

 

HIV-positive

Contact > 15 min of mucous membrane or non-intact skin
Genital
secretions
Anal or vaginal sex and not on PrEP or low PrEP adherence Viraemic HIV-positive or serostatus unknown but presence of HIV risk factors. If source person is on ART, PEP should be started, HIV-VL should be repeated, and, if undetectable, PEP can be stopped
Receptive oral sex with ejaculation and not on PrEP or low PrEP adherence Viraemic HIV-positive
Intravenous drug use Exchange of syringe, needle, preparation material or any other material HIV-positive
  • Rapid testing of the source person for HCV and HIV (if HIV-status unknown) recommended
  • If source person HIV-positive on ART, order resistance testing if HIV-VL detectable
  • Individualise PEP according to the source’s treatment history and previous resistance tests
  • For sexual exposure, if HIV-positive source has documented undetectable HIV-VL, PEP is no longer recommended
  • PEP to be started ideally < 4 hours after the exposure, and no later than 48/72 hours
  • Duration of PEP: 4 weeks (unless discontinued due to lack of indication)
  • PEP regimens: TDF/FTC or TAF/FTC (alternative: ZDV/3TC) + RAL bid or qd, or + DRV/r qd. TDF/FTC or TAF/FTC+ DTG qd or TAF/FTC/BIC may be also considered as alternatives
  • Full sexual health screen in case of sexual exposure
  • Emergency contraception counselling for sexual exposure
  • Follow-up:
    • HIV serology + HBV and HCV, pregnancy test (women) within 48 hours of exposure
    • Re-evaluation of PEP indication by HIV expert within 48-72 hours
    • Assess tolerability of PEP regimen
    • Transaminases, HCV-PCR and HCV serology at month 1 if source person HCV-positive (observed or suspected)
    • HIV serology at the end of PEP and one month later
    • Discuss opportunity to start PrEP