PEP Flashcards
(13 cards)
Index partner HIV POS PEP
PEP is not recommended if the index partner has been on ART for at least 6 months with an undetectable plasma HIV viral load (at the time of last measurement and within the last 6 months) and with good reported adherence
If there are any doubts about the ART history, the index partner’s adherence to ART or the viral load, then PEP should be given following condomless receptive anal intercourse.
PEP Sharps index HIV positive
PEP is recommended following a high-risk injury (sharps or mucosal splash) if the index case is known to be HIV-positive and is not on ART for >6 months with a suppressed viral load within the last 6 months.
If suppressed VL, case by case but generally NOT recommended.
PEP sharp/ splash index HIV unknown
PEP is not recommended following a sharps or mucosal splash injury if the index case is untested but from a low risk group.
High risk group - NOT recommended unless additional risk factors.
NOTE - if index case unconscious, can test HIV without consent!
PEP Human bites
patients who fulfil ALL of the three following criteria:
a) the biter’s saliva was visibly contaminated with blood;
b) the biter is known or suspected to have a plasma HIV viral load >3.0 log copies/ml; and
c) the bite has resulted in severe and/or deep tissue injuries.
PEP IVDU
PEP is recommended for PWID after sharing needles/equipment if their index injecting partner is HIV-positive and not ART for > 6 months with a suppressed viral load.
PEP is generally not recommended in PWID after sharing needles/equipment with an injecting partner of unknown HIV status from a high prevalence country / risk-group but PEP can be considered on a case-by-case basis for PWID in the context of a localised outbreak.
PEP drug of choice
TDF 245mg/emtricitabine 200mg + raltegravir 1200mg OD
Pregnancy PEP drug
For women who are pregnant or at risk of pregnancy, raltegravir 400mg twice daily (normal
Dose 1200mg OD) is preferred (with tenofovir disoproxil 245mg/emtricitabine 200mg)
PEP timing
ASAP, preferably within 24h.
MAX 72h.
Total duration: 28 days.
Baseline test in PEP
Creatinine & eGFR
ALT
HIV serology
HBV serology
Syphilis and HCV serology in sexual exposure
Pregnancy test
Repeat HIV testing in PEP
MINIMUM 45 days after exposure
73 Days if completing 28 day PEP.
Indication for PEP in people
Taking PrEP
Anal sex: If the only exposure has been though anal sex and where fewer than three tablets have been taken within the last 7 days or where the last dose was more than 7 days ago, PEP is recommended.
Vaginal: Where the potential HIV exposure is through vaginal sex and PrEP adherence has been suboptimal, PEP should be considered if more than 48 hours have elapsed since last dosing or if fewer than six tablets have been taken within the previous 7 days.
Frontal or neovaginal sex: Where the potential exposure to HIV is through frontal sex in trans men or through neovaginal sex in trans women, then PEP should be considered if more than 48 hours have elapsed since last dosing or if fewer than six tablets have been taken within the previous 7 days.
Further exposure whilst on PEP
In the event of a further high-risk sexual exposure during the last two days of the PEP course, PEP should be continued until 48 hours after the last high-risk exposure for anal sex or until 7 days after the last high-risk exposure for vaginal/frontal sex.
PEP recommended scenarios
A. Index HIV positive AND VL detectable or unknown:
- Receptive anal sex
- Insertive anal sex
- Receptive vaginal sec
- CONSIDER in insertive vaginal sex
- Sharing of injecting equipment
- Sharps injury
- Mucosal splash
B. Index HIV positive AND VL UNDETECTED:
NOT recommended
C. Index unknown from high prevalence country OR group;
- Receptive anal sex
- CONSIDER in insertive anal sex
D. Index unknown from low prevalence:
NOT recommended
