PEP Flashcards
(50 cards)
What are the baseline post exposure investigations for the source?
HIV Rapid and ELISA
HBsAg
HCV Ab
RPR/TPHA
What are the baseline post exposure investigations for the exposed?
HIV Rapid and ELISA
HBsAb
HCV Ab
Beta-HCG
RPR/TPHA (if source +ve)
Creat (TDF)
FBC (AZT)
When is HIV prophylaxis required?
Exposure to infectious bodily fluids or sexual exposure
Within 72 hours
When is HIV prophylaxis not required?
Exposed +ve
Source -ve and window period excluded
When is HBV prophylaxis required?
Exposure to infectious bodily fluids, sexual exposure and human bites
How do you give HBV prophylaxis
- HBV vaccine
3 doses at monthly intervals
Within 7d of non-sexual exposure
Within 14d of sexual exposure - HBIG 500IU
Within 72 hours
Immediately protective, 75% efficacy, lasts 3-6m
Do not delay >24h
When is HBV prophylaxis not required?
Exposed +ve
Exposed vaccinated with HBsAb >10IU
Source -ve
When do you give emergency contraception?
Within 5d of sexual exposure
When is emergency contraception not required?
Exposed is pregnant
Exposed uses other contraceptives
Prepubescent girls without breast development
When do you give STI prophylaxis?
Within 72h of sexual exposure
When do you give tetanus prophylaxis?
Wounds, cuts, bite
Within 48h
When is tetanus prophylaxis not required?
3 doses of tetanus vaccine previously
What counselling must be given post exposure?
Potential conditions
PEP risks, benefits, effectivity, instructions, side effects
Investigations
Follow up appointments
Emotional support
Condom use up to 4 months post exposure
What is the follow up schedule post exposure?
2 weeks: creat (TDF), FBC (AZT)
6 weeks: HIV rapid and ELISA, HCV PCR, pregnancy test if no menses
4 months: HIV rapid and ELISA, HBsAg, RPR/TPHA
What makes an exposure high risk?
Larger fluid qualities
High VL
What is the law regarding HIV testing of alleged offenders?
Within 90d of offence
What is the PEP regimen?
TLD 300/300/50
What is the PEP regimen if DTG is not tolerated?
TDF/FTC 300/200
PLUS
Atazanavir 300/100 dy
OR
Lopinavir/r 200/50 2 tablets bd
What is the PEP regimen if TDF is not tolerated?
AZT 300mg bd
PLUS
3TC 150mg bd
What are the common side effects of PEP drugs?
TDF - nephrotoxicity
DTG - insomnia
AZT - N+V, headache, insomnia, fatigue
Atazanavir - UC hyperbilirubinemia, hepatitis, rash
Lopinavir - GIT intolerance
When can consent be given by a child for HTS?
- > 12yo
- <12yo with sufficient maturity
- Patient, caregiver or HOD
How do you initiate PEP <18m?
Do PCR
Initiate PEP
Follow up PCR within 48h
-ve continue PEP
+ve ART and confirm with PCR
How do you initiate PEP >18m?
Do HIV rapid
-ve initiatie PEP
+ve ART and confirm with PCR/VL
How do you intiate PEP >24m?
Adult testing algorithm
