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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 |
Viraemic HIV-positive or serostatus unknown |
|
| 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 |
| Consider PEP in case of receptive oral sex with ejaculation and not on PrEP or low PrEP adherence1 | Viraemic HIV-positive | |
| Intravenous drug use | Exchange of syringe, needle, preparation material or any other material | HIV-positive |
1 As defined in PrEP section
- Rapid testing of the source person for HBV, 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 72 hours
- Duration of PEP: 4 weeks (unless discontinued due to lack of indication)
- PEP regimens: TDF/FTC or TAF/FTC + RAL bid or qd, or + DRV/b qd, or + DTG qd,or TAF/FTC/BIC
- 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 and test for STIs if appropriate
- Assess tolerability of PEP regimen
- Transaminases, HCV-PCR and HCV serology at month 1 if source person HCV-positive (observed or suspected)
- Follow-up HIV serology: mandatory at the end of PEP and repeat 6-8 weeks later
- Discuss opportunity to start PrEP if sexual exposure to HIV likely in future