Post-exposure HIV prophylaxis

Case history #1

A 25-year-old man presents to the emergency department, anxious about an episode of unprotected receptive anal intercourse 12 hours ago. He has had no other sexual partners in the last 3 months, and prior to that had a long-term male partner with whom he had regular anal intercourse using condoms. He is asymptomatic, but he had rectal gonorrhea treated 2 years ago. He has no medical history and is not taking any medications. He does not use recreational drugs. He had a negative HIV test 6 months ago and is fully vaccinated against hepatitis A and B.

Case history #2

A 22-year-old man who works as a phlebotomist in the HIV outpatient clinic presents at the occupational health department. He sustained a needlestick injury in clinic just 1 hour before. The blood belonged to a 30-year-old HIV-positive woman who was nonadherent with her antiretroviral medications and who had recently tested negative for hepatitis B and C. The phlebotomist had taken blood and, as he took the needle out, the patient moved suddenly and the needle pricked his finger through his glove. He quickly took off his glove and squeezed his finger under running water to encourage bleeding. He has no significant medical history and is not taking any medications. He is fully vaccinated against hepatitis B. He has a regular female sexual partner.

Other presentations

Other common presentations for post-exposure prophylaxis (PEP) following sexual exposure include heterosexual partners of people living with HIV following condom rupture. People who have been sexually assaulted should also be considered for PEP.

Nonsexual exposure to HIV can also be an indication for PEP, usually in the occupational setting. Data from the UK Department of Health on occupational PEP showed that 57% of healthcare workers exposed to an HIV-positive source started PEP following a percutaneous exposure, and others started PEP for other indications such as mucocutaneous exposures.[5]Department of Health. HIV post-exposure prophylaxis: guidance from the UK Chief Medical Officers' Expert Advisory Group on AIDS. Sep 2008 [internet publication]. https://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_089997.pdf

Prevention of perinatal transmission of HIV has historically included some PEP for the infant, but is largely successful due to effective antiretroviral therapy given to pregnant women. Prevention of perinatal transmission is not covered in this topic. See HIV infection in pregnancy.