Post Exposure Prophylaxis

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In people who have been exposed to HIV through needle-stick inoculation or through contamination of mucous membranes by secretions, it has been shown that administration of ARVs within 72 hours of exposure reduces the likelihood of HIV infection being transmitted. There are also similar benefits of reduction of HIV transmission following use of PEP within 72 hours for those who have been sexually assaulted (rape, intimate partner violence or sexual abuse) or had a high risk unprotected sexual encounter. In these situations, ART needs to be continued for one month. The following guidelines should be followed in the event of accidental occupational exposure to material (i.e., blood, secretions, and excretions) that may contain HIV, and also after sexual assault or high risk sexual encounter. Occupational exposure to potentially infectious material may occur through an injury with a sharp object that has been used on a patient or through the contamination of mucous surfaces with patients' blood or secretions.

The following types of exposures should be considered for post-exposure prophylaxis:

  • Needle-stick injury or injury with a sharp object used on a patient
  • Mucosal exposure of the mouth or eyes by splashing fluids
  • Broken skin exposed to a small volume of blood or secretions such as may occur with sexual assault (rape, intimate partner violence or sexual abuse)

Occupational exposure can be classified as high risk or low risk for HIV infection, as follows:

Low risk:

  • Small volume (e.g., drops of blood) on mucous membranes or non-intact skin
  • Source patient asymptomatic or with VL less than 1,500 copies/ml

High risk:

  • Large-bore needle, deep injury
  • Large-volume splash on mucous membranes or non-intact skin
  • Source patient symptomatic or with high VL levels

Adults/Adolescents:

Preferred Regimen  

TDF/3TC/DTGa OD

Alternative Regimen  

TDF/3TC/ATV/rb OD

a,b Available at all health facilities from clinic upwards as starter pack and one-month course.

Main Considerations:

There should be no delay in starting the best available starter pack in situations where resistance is suspected. Start the best available starter pack and then get expert advice on way forward.