prescribing Post-Exposure Prophylaxis Following Sexual Exposure (PEPSE)
PEP is not considered 100% effective, as there have been cases of HIV acquisition whilst on PEP. These may be related to
- delayed initiation
- transmission of resistant virus
- variable genital tract drug penetration
- poor/non-adherence
- further high risk sexual exposures
Recommendations of British Association of Sexual Health and HIV (BASHH):
- PEPSE should be used where there is a significant risk of HIV transmission
- HIV status of source is
- unknown - proactive attempts are made to establish the HIV status
- known to be positive
- attempts should be made at the earliest opportunity to determine the HIV viral load, resistance profile and treatment history
- PEPSE is no longer recommended if the source is on antiretroviral therapy (ART) with a confirmed and sustained (>6 months) undetectable plasma HIV viral load (<200c/ml)
- however, if there are any doubts about the HIV viral load history or the source "s adherence to ART then PEP should be given following unprotected receptive anal intercourse
- truvada and raltegravir is the regimen of choice for PEPSE
- PEPSE should be initiated as soon as possible after exposure, preferably within 24 hours, but can be considered up to 72 hours
- giving PEPSE beyond 72 hours is not recommended
- duration of PEPSE should be 28 days
- follow-up HIV testing at 8-12 weeks after exposure should be carried out
- pregnancy testing should be undertaken in women considering PEPSE
- pregnancy should not alter the decision to start PEPSE
- women must be counselled that antiretroviral agents used for PEPSE are unlicensed in pregnancy and risks / benefits must be carefully discussed
- in the event of a further high-risk sexual exposure in the last two days of the PEPSE course the PEP should be continued for 48 hours after the last high-risk exposure
- if the HIV test is positive after PEPSE has already been initiated we recommend continuing PEPSE pending review by an HIV specialist
- individuals experiencing a skin rash or flu-like illness during or after taking PEPSE should be advised to attend for urgent review to exclude an HIV seroconversion illness
Guidance on missed doses of PEPSE:
- <24 hours elapsed since last dose - take missed doses immediately and subsequent doses at usual time
- 24-48 hours elapsed since last dose - continue PEPSE
- >48 hours since last dose - recommend to stop PEPSE (1)
Reference: