Post Exposure Prophylaxis (PEP) is the immediate provision of preventive measures and medication following exposure to potentially infected blood or other bodily fluids in order to minimize the risk of acquiring infection. Several clinical studies have demonstrated that HIV transmission can be reduced by 81% following immediate administration of antiretroviral agents.
Effective post-exposure management entails the following elements:
- Management of exposure site
- Exposure reporting
- Assessment of infection risk
- Appropriate treatment
- Follow-up and counselling
When an exposure occurs, the circumstances and post exposure management procedure applied should be recorded in the exposed person’s confidential form for easy follow up and care.
Evaluation of the Exposed Individuals
Individuals exposed to HIV should be evaluated within two hours and no later than 72 hours. A starter pack should be initiated within 2 hours after exposure and before testing the exposed person. Exposed healthcare workers should be counselled and tested for HIV at baseline in order to establish infection status at the time of exposure. PEP should be discontinued if an exposed healthcare worker refuses to test. Vaccination against Hepatitis B should be considered.
In addition, rape survivors should be:
- Offered counselling, crisis prevention and provision of an on-going psychosocial support to reduce/minimize immediate rape trauma disorder and long-term post-traumatic stress disorder should be offered.
- Referred to mental care, police and legal services, according to the law and regulations.
Evaluation of the Source Person
Evaluation of the source person should be performed when the exposed individual agrees to take PEP.
- If the HIV, HBV and HCV status of the source person is unknown perform these tests after obtaining consent. The exposed healthcare worker should not be involved in obtaining consent from the source person.
- If the source person is unknown, evaluation will depend on other risk criteria.
- Do not test discarded needles or syringes for viral contamination.
ARVs used for HIV PEP
Adults
A: TDF 300mg+3TC 300mg+DTG 50mg (FDC) (PO) 24hourly for 4weeks
Children (based on body weight)
A: AZT+3TC+LPV/r 12hourly for 4weeks
Children whose weight is more than 20kg DTG can be used instead of LPV/r and maintain AZT+3TC as backbone.
Note: If the source is using PI based regimen, then the PEP regimen should be PI based. (Similar to the source’s regimen)
Follow-up of HIV Exposed individuals
HIV antibody tests should be performed at least after 4–6 weeks’ post-exposure (i.e. at 6 & 12 weeks). HIV testing should also be performed for any exposed person who has an illness that is compatible with an acute retroviral syndrome, irrespective of the interval since exposure.
If PEP is administered, the exposed person should be monitored for drug toxicity at baseline and 2 weeks after starting PEP. Minimally, it should include a Full Blood Count (FBC), renal function test (RFT-Serum creatinine and urinalysis) and hepatic function tests (LFT-ALT).
Exposed persons should be re-evaluated within 72 hours, after additional information about the source of exposure including serologic status, viral load, current treatment, any resistance test results (if available) or information about factors that would modify recommendations, is obtained.
PEP should be administered for 4 weeks if tolerated. If not tolerated manage symptoms accordingly and if intolerance persists, change to more tolerable PI based regimen. If the patient seroconverts and the exposed person becomes HIV infected, he/she should be referred to a CTC for proper care and treatment service.
