HIV Prevention Knowledge Base
Biomedical Interventions: Post-exposure Prophylaxis (PEP)
Post-exposure Prophylaxis to Prevent HIV Infection: Joint WHO/ILO Guidelines on Post-exposure Prophylaxis (PEP) to Prevent HIV Infection.
These are joint WHO and ILO guidelines on PEP to prevent HIV infection. They aim to provide a unified framework to guide both PEP policy development and the implementation of services for occupational and nonoccupational HIV exposures, with a focus on occupational exposure and exposure through sexual assault. This document does not provide detailed guidance relating to exposure through injecting drug use or through consensual sex.
Management of Non-Occupational Post Exposure Prophylaxis to HIV (NONOPEP): Sexual, Injecting Drug User or Other Exposures.
EURO-NONOPEP is a collaboration of 14 European countries. The goals of the collaboration are to collect and describe the PEP guidelines of all participants to evaluate PEP-related knowledge among patients and providers, and to maintain a registry of nonoccupational HIV exposures.
Antiretroviral Post-exposure Prophylaxis After Sexual, Injection-Drug Use, Or Other Nonoccupational Exposure to HIV in the United States: Recommendations from the U.S. Department of Health and Human Services.
The CDC recommends prompt initiation of PEP with highly active ART (HAART) for persons who seek care within 72 hours after a nonoccupational exposure to infectious body fluids of a person with known HIV infection, if the exposure event presents a substantial risk for transmission. HAART should be continued for 28 days. Exposures are defined as “any direct mucosal, percutaneous, or intravenous contact with potentially infectious body fluids that occurs outside perinatal or occupational situations. Potentially infectious body fluids are blood, semen, vaginal secretions, rectal secretions, breast milk, or another body fluid that is contaminated with visible blood.” When the HIV status of the source is not known and the patient seeks care within 72 hours after exposure, the CDC does not recommend for or against PEP but encourages clinicians and patients to weigh the risks and benefits on a case-by-case basis. When the transmission risk is negligible or when patients seek care more than 72 hours after a substantial exposure, PEP is not recommended. However, clinicians might consider prescribing PEP for patients who seek care more than 72 hours after a substantial exposure if, in their judgment, the diminished potential benefit of PEP outweighs the potential risk for adverse events from ARV medications.
Post Exposure Prophylaxis Guidelines for Occupational Exposure
This document gives NACO’s clear and concise guidelines for preventing and responding to occupational injuries that expose hospital workers and others to HIV. Separate flow charts detailing the differential levels of risk associated with types of injuries and the HIV status of the exposure source were developed to evaluate whether PEP would be recommended, and if so, the type of regimen that is most appropriate.
Offering HIV Post-Exposure Prophylaxis (PEP) Following Non-Occupational Exposures: Recommendations for Health Care Providers in the State of California
This document offers a comprehensive discussion of the critical issues that medical providers must consider before offering PEP for HIV in cases of nonoccupational exposure. Areas covered include the elapsed time from the event to referral, type of exposure and its associated risk (e.g., receptive/insertive anal or vaginal intercourse; shared needle), and the actual or likely HIV status of the source person or instrument. A summary of key studies on these issues and research on drug regimens used in different circumstances provides good background information for providers. Also useful are the patient information sheets on frequently asked questions, patient information forms, and provider scripts on topics that should be discussed with patients, which are provided in appendices.
HIV PEP: Now There is a Treatment that May Prevent HIV Infection After the Virus has Entered the Body
This colorful five-page booklet is intended to raise awareness among MSM about the availability of emergency PEP for HIV. Using a question and answer format (“We had unsafe sex . . . the condom broke. . . is it worth asking for PEP?”), and written in plain, nontechnical language, the pamphlet describes the who, what, where, and when of PEP—namely, eligibility, factors affecting success, how and where treatment is administered, and possible side effects.
PEP Online Self-Assessment
This website offers a brief online questionnaire that assesses eligibility for PEP. A series of questions establish when the exposure occurred and the actual or likely HIV status of the partner and recommends whether PEP is indicated or not. The site also offers links to a sexual assault hotline, how to find PEP administration centers, and easily accessible information about PEP that can be downloaded.
Development of Guidelines on Nonoccupational HIV Postexposure Prophylaxis for the State of Rhode Island
This article describes the history of the U.S. state of Rhode Island’s developing PEP guidelines. Rhode Island was the first state to establish such guidelines, which were disseminated in 2002. The key elements of the guidelines (context, timing, consent and testing, and recommended regimens) are summarized. However, the information in the guidelines is not as clear, nor as comprehensive, as guidelines that were published subsequently by the U.S. Government or by international organizations. Also, the drug regimens do not take into account recent research on adverse side effects associated with some multidrug regimens.