HIV non-occupational post-exposure prophylaxis and pre-exposure prophylaxis

People not receiving human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) who seek care within 72 hours after an isolated sexual or injection-related HIV exposure should be evaluated for the need for non-occupational post-exposure prophylaxis (nPEP) (1). nPEP may also be considered where an individual receiving PrEP reports being poorly adherent and seeks care within 72 hours after an HIV exposure. The clinician should take a sexual history to differentiate isolated exposures from ongoing exposure. If the exposure is isolated (e.g. an isolated condom failure, sexual assault), nPEP should be prescribed, but ongoing antiretroviral medication is not indicated after completion of the 28-day nPEP course.

If exposures are not isolated but ongoing, clinicians should consider offering PrEP immediately. If the person needs a three-drug nPEP regimen, the nPEP should be prescribed initially and then the individual should be supported to transition to PrEP.

The decision to commence nPEP should be made according to local nPEP guidelines (1). The decision to transition to PrEP is dependant upon suitability for PrEP (including a confirmatory negative HIV test result) and the individual’s willingness to continue taking daily tenofovir disoproxil* and emtricitabine (TD*/FTC) and to attending quarterly clinic visits whilst on PrEP.

For a person already using PrEP, a course of nPEP may be required if the PrEP user had a recent high-risk exposure (within 72 hours) and did not take PrEP during the period that the high-risk exposure occurred. The decision to recommence PrEP following a course of nPEP is dependent upon the individual’s ongoing eligibility for PrEP (including a negative HIV test result) and their willingness to continue taking daily TD*/FTC.