Post-exposure prophylaxis for HIV
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HIV post-exposure prophylaxis (PEP)
Exposures
- Can be sexual or non-sexual; consensual or non-consensual; and heterosexual or homosexual
Risk Assessment
| Level | Exposure | Estimated risk per act % |
|---|---|---|
| Very high | Transfusion | 92.5 |
| High | Anal (receptive) | 1.38 |
| Needle sharing | 0.63 | |
| Moderate | Anal (insertive) | 0.11 |
| Vaginal (receptive) | 0.08 | |
| Vaginal (insertive) | 0.04 | |
| Low | Oral sex (giving) | — |
| Oral sex (receiving) | — | |
| Oral-anal contact | — | |
| Sharing sex toys | — | |
| Blood on compromised skin | — |
Investigations
- HIV testing at baseline and 12 weeks
- HAV-Ab, HBsAg/sAb/cAb at baseline
- HCV-Ab at baseline and 12 weeks
- Gonorrhea and chlamydia of urine, throat, and rectum at baseline and 12 weeks
- Sypthilis at baseline and 12 weeks
- CBC at baseline
- ALT and creatinine at baseline, repeated at 2 weeks if abnormal
- Pregnancy test at baseline
Treatment
- Screen for sexual assault, counsel about safe sex
- Start treatment within 72 hours
- Tenofovir/emtricitabine 300/200 with raltegravir 400 BID, for 28 days
- Preferred alternatives include TDF/FTC with darunavir/ritonavir or dolutegravir
- Other alternatives include many
- Don't forget above screening
Follow-up
- Initial visit; follow-up at 4-6 weeks; then repeat bloodwork at 4 months
- Take advantage of the opportunity to counsel patients on STIs, substance use, etc.
Further Reading
- Tan et al. Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. CMAJ 2017;189(47):e1448-e1458.
