Post-exposure prophylaxis for HIV: Difference between revisions
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+ | ==Exposures== |
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+ | *Can be sexual or non-sexual; consensual or non-consensual; and heterosexual or homosexual |
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+ | ==Risk Assessment== |
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+ | !Level |
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+ | !Exposure |
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+ | ! align="center" |Estimated risk per act % |
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+ | |Very high |
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+ | |Transfusion |
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+ | | align="center" |92.5 |
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| − | | High |
+ | | rowspan="2" |High |
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+ | |Anal (receptive) |
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+ | | align="center" |1.38 |
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| − | | Moderate |
+ | | rowspan="3" |Moderate |
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+ | |Anal (insertive) |
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+ | | align="center" |0.11 |
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| − | | Low |
+ | | rowspan="5" |Low |
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+ | |Oral sex (giving) |
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+ | | align="center" |— |
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| − | == |
+ | ==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 |
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+ | *Sypthilis at baseline and 12 weeks |
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+ | *CBC at baseline |
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+ | *ALT and creatinine at baseline, repeated at 2 weeks if abnormal |
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+ | *Pregnancy test at baseline |
| − | == |
+ | ==Treatment== |
| − | * |
+ | *Screen for sexual assault, counsel about safe sex |
| − | * |
+ | *Start treatment within 72 hours |
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+ | *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''. [https://doi.org/10.1503/cmaj.170494 Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis]. ''CMAJ'' 2017;189(47):e1448-e1458. |
[[Category:HIV]] |
[[Category:HIV]] |
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Revision as of 21:26, 7 September 2020
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.
