HIV PEP: post exposure prophylaxis
PEP = Post-exposure prophylaxis. Previously known as PEP (usually occupational exposure) or PEPSE (following sexual exposure), now known as PEP.
- Cases should be risk assessed on an individual basis, taking into account nature of exposure and the source.
- Sexual exposures should be referred to the Sexual Health clinic during their opening hours
- Occupational exposures should only receive PEP after discussion with an Infectious Diseases consultant or SpR
- PEP should be started as soon as possible after exposure. Ideally within 24hours (but up to 72hours is indicated). PEP is NOT indicated after 72 hours.
TTO packs (for 28 days of treatment) are available from:
- Pharmacy (JR, Churchill and Horton)
- Oxford and Banbury Sexual Health Departments
- Emergency Drug Cupboards at the JR, Churchill and Horton (for out of hours use only – contact on-call Pharmacist via switchboard to access).
Anyone presenting for PEP more than 72 hours after exposure should be referred to occupational health (COHWB) or Sexual health, depending on the nature of exposure, as a non-emergency.
Preferred
Tenofovir disoproxil 245mg / emtricitabine 200mg 1 tablet po od
AND
Raltegravir 1200mg po od (2x 600mg tablets only, do not use the 400mg tablets)
Duration: 28 days
The above regimen is not suitable during pregnancy. Speak to Micro/ID.
To prescribe use ED PEP/PEPSE PowerPlan.
Note: PEP TTO packs only should be used. These contain 30 days supply and patients are advised to discard the unused tablets.
Alternative
If the source of infection is known or believed to have a resistant virus, or if the first line drugs are not appropriate (e.g. in renal impairment, pregnancy), alternative drugs may be prescribed. The decision for using alternative drugs should be undertaken by an HIV specialist.
Advice to be given to the patient
- Take the first dose immediately and complete the course (28 days).
- Ensure they understand how to take the tablets (i.e. dose, frequency, duration).
- Ensure there are no interacting medications. Advise patients not to take any indigestion remedies, calcium or iron supplements less than 4 hours before or after raltegravir.
- Advise the patient about potential side effects, including potential depression and suicidal ideation with raltegravir.
- Inform them of the details for follow-up (with sexual health or occupational health) and emphasise the importance of attending follow-up appointments.
Further advice
Following Occupational Exposure:
Supplies and Follow up
During normal working hours: Cases potentially requiring PEP will be dealt with through the Micro/ID SpR, or the occupational health department for members of staff.
Out-of-hours: For any occupational exposures or potential PEP cases, the on-call Micro/ID SpR should be contacted to arrange assessment.
Follow up should be arranged in an Infectious Diseases and/or Sexual Health clinic or as a day attender at the John Warin ward or Rowan Day unit as soon as possible.
Following Sexual Exposure:
Supplies and Follow up
During working hours (See HERE for opening hours) : Cases potentially requiring PEP are assessed by Oxford Sexual Health Service who will issue a prescription for PEP which the patient collects from pharmacy.
Out-of-hours: Potential PEP cases should be referred to the nearest emergency department (ED) where the required triage paperwork should be completed to assess whether PEP is required. See ‘Standard Operating Procedure for out of hours Post Exposure Prophylaxis for HIV via Emergency Departments’
Follow up should be arranged with Oxford Sexual Health Service as soon as possible.
Contact details for the sexual health clinics:
- Oxfordshire Sexual Health Service: (2)31231 (main reception)
- https://www.sexualhealthoxfordshire.nhs.uk/