| POST-EXPOSURE PROPHYLAXIS |
| |
POST-EXPOSURE PROPHYLAXIS (PEP) RECOMMENDED IF |
| Nature of exposure |
Status of source patient |
| Blood |
Subcutaneous or intramuscular penetration with IV or IM needle, or intravascular device |
HIV +
Or serostatus unknown but presence of HIV risk factors |
- Percutaneous injury with sharp instrument (lancet), IM or SC needle, suture needle
- Contact > 15 min of mucous membrane or non intact skin
|
HIV + |
| Genital secretions |
Anal or vaginal sex |
HIV +
Or serostatus unknown but presence of HIV risk factors |
| Receptive oral sex with ejaculation |
HIV + |
| Intravenous drug user |
Exchange of syringe, needle, preparation material or any other material |
HIV + |
|
- Rapid testing of the source patient for HCV and HIV (if HIV status unknown) recommended,
- If source patient HIV+ on ARV therapy, order genotyping testing if HIVRNA > 1000 copies/μL
- If prior resistance test available in source patient, individualize the PEP therapy accordingly
- PEP to be started ideally < 4 hours after the exposure, and no later than 48 hours
- Duration of PEP: 4 weeks
- Standard PEP regimen: TDF/FTC (alternative: ZDV/3TC) + LPV/r tablets 400/100 mg bid
- Full sexual health screen in case of sexual exposure
- Follow-up:
- HIV serology + HBV and HCV, pregnancy test
- (women) within 48 hours of exposure
- Reevaluation of PEP indication by HIV expert within 48-72 hours
- Assess tolerability of ARV PEP regimen
- Transaminases, HCV-PCR and HCV serology at month 1 if source of exposure were HCV+ (observed or suspected)
- Repeat HIV serology after 2 and 4 months, syphilis serology after 1 month if sexual exposure
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