Post-Exposure Prophylaxis (PEP)

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Post-Exposure Prophylaxis (PEP) is the use of ARVs to prevent HIV transmission. Non-occupational exposure to HIV in children and adolescents is mostly attributed to sexual abuse. In adults, exposure to HIV is mostly associated with occupational injuries. The risk of acquiring HIV infection after occupational exposure to HIV-infected blood is low (1:300 after percutaneous exposure to < 1:1,000 after mucocutaneous exposure). Preferred ARV choice is TDF or TAF + XTC + DTG and alternative are TDF or TAF + FTC + DRV-r or TDF or TAF + XTC + LPV-r

There is no risk of transmission when the skin is intact. Factors associated with an increased risk include deep injury, visible blood on the device that caused the injury, injury with a large bore needle from artery or vein, and unsuppressed HIV viral load in source patient. Body fluids and materials that pose a risk of HIV transmission are amniotic fluid, cerebrospinal fluid, human breast milk, pericardial fluid, peritoneal fluid, pleural fluid, saliva in association with dentistry, synovial fluid, unfixed human tissues and organs, vaginal secretions, semen, any other visibly blood-stained fluid, and fluid from burns or skin lesions. Other blood- borne infections are Hepatitis B and Hepatitis C viruses which pose a heightened risk of HIV infection. Thus, all HCWs should receive HBV vaccination.

Non-Occupational Post-Exposure Prophylaxis (nPEP) is the provision of ARVs to individuals with significant exposure to HIV within 72 hours. This should be given especially to individuals who have been sexually assaulted where the HIV status of the assailant is unknown or in any other circumstance where there is significant exposure to HIV contaminated body fluid. 

Clients who come for non-Occupational PEP should be evaluated for substantial risk behaviour for HIV acquisition. Those with substantial risk or repeated requests for non-Occupational PEP must be counselled for PrEP.

The drugs for nPEP are the same as those for PEP due to occupational exposure as shown above.