Patient discussions

  • The patient should be instructed about the purpose of post-exposure prophylaxis (PEP) and the rationale behind using antiretroviral medication to prevent the transmission of HIV. The efficacy of PEP and limitations of data must be addressed so that the person can make an informed decision whether to start on the PEP regimen.

  • Duration of PEP should be explained and the importance of completing the full 28-day regimen stressed. Medications should be taken as prescribed.

  • Patients should be warned about adverse effects such as fatigue, headache, rash, nausea, and diarrhea, and toxicities such as liver dysfunction should be discussed. Patients should be advised to seek medical help if they experience severe adverse effects or are concerned about their clinical state.

  • Risk-reduction strategies for the future should be discussed, including pre-exposure prophylaxis (PrEP) and the option to transition directly to PrEP on completion of PEP for high-risk individuals. The importance of safe sex, especially in the 3-month HIV window period, should be covered. This is particularly important in people who have had multiple sexual exposures to HIV.

  • People should be warned about potential drug interactions with the PEP regimen. This must include over-the-counter medications as well as prescribed medications.

  • HIV pre-test discussion should be carried out prior to the baseline HIV test and investigations and importance of follow-up made clear.

  • Patients should be monitored for development of psychological issues surrounding PEP and should be referred as necessary to specialist services. This may especially apply to those who have been sexually assaulted. For patients who have experienced rape or other sexual assaults, referrals to rape crisis groups, support with social workers and case managers, and discussion of any ongoing domestic violence risk should be undertaken. Children and adolescents who are sexually assaulted should ideally be managed in the emergency room or other setting where age-appropriate resources are available to address the multiple medical, psychosocial, and legal issues related to such an offense.

  • Patients should also be counseled regarding the symptoms of HIV seroconversion. A flu-like illness with fever, sore throat, rash, diarrhea may occur, but more severe symptoms have also been documented. This may occur up to 12 weeks after exposure.[55]

Use of this content is subject to our disclaimer