Content From: HIV.gov•Updated: April 28, 2021•3 min read Show
TopicsWhat Is PEP?PEP, or post-exposure prophylaxis, is a short course of HIV medicines taken very soon after a possible exposure to HIV to prevent the virus from taking hold in your body. You must start it within 72 hours (3 days) after a possible exposure to HIV, or it won’t work. Every hour counts! PEP should be used only in emergency situations. It is not meant for regular use by people who may be exposed to HIV frequently. How Do You Know If You Need PEP?PEP may be right for you if you are HIV-negative or don’t know your HIV status, and you think you may have been exposed to HIV in the last 72 hours:
Contact your health care provider immediately or go to an emergency room or urgent care clinic right away. Your health care provider or emergency room doctor will evaluate you, help you decide whether PEP is right for you, and work with you to determine which medicines to take for PEP. In addition, if you are a health care worker, you may be prescribed PEP after a possible exposure to HIV at work, such as from a needlestick injury. How Long Do You Need to Take PEP?If you are prescribed PEP, you will need to take the HIV medicines every day for 28 days. You will also need to return to your health care provider at certain times while taking PEP and after you finish taking it for HIV testing and other tests. How Well Does PEP Work?PEP is effective in preventing HIV infection when it’s taken correctly, but it’s not 100% effective. The sooner you start PEP after a possible HIV exposure, the better. While taking PEP, it’s important to use other HIV prevention methods, such as using condoms the right way, every time you have sex and using only new, sterile needles and works when injecting drugs Does PEP Cause Side Effects?PEP is safe, but the HIV medicines used for PEP may cause side effects like nausea in some people. In almost all cases, these side effects can be treated and aren’t life-threatening. If you are taking PEP, talk to your health care provider if you have any side effect that bothers you or that does not go away. PEP medicines may also interact with other medicines that a person is taking (called a drug interaction). For this reason, it’s important to tell your health care provider about any other medicines that you take. Can You Take PEP Every Time You Have a Potential Exposure to HIV?No. PEP should be used only in emergency situations. It is not intended to replace regular use of other HIV prevention methods. If you feel that you might exposed to HIV frequently, talk to your health care professional about PrEP (pre-exposure prophylaxis). Can You Get Help Paying for PEP?
Updated: June 18, 2021 These NCCC post-exposure prophylaxis (PEP) recommendations will help you with urgent decision-making for occupational exposures to HIV and hepatitis B and C. Consultation can be obtained from Occupational Health or Employee Health Services, local experts, or the NCCC’s PEPline. See the PEPline page for current hours and availability. The CDC’s occupational post-exposure guidelines can be accessed on our PEP Guidelines page. Commonly Asked QuestionsInitial Evaluation: Assessing Exposures and TestingWhat immediate measures should be taken? What is considered to be a potential exposure to HIV, HBV or HCV? • Note that saliva, vomitus, urine, feces, sweat, tears and respiratory secretions do not transmit HIV (unless visibly bloody). The risks of HBV and HCV transmission from non-bloody saliva are considered to be negligible. The PEPline does not recommend routine HIV, HBV or HCV surveillance testing following exposure or possible exposure to non-bloody saliva.* * Federal guidelines consistently emphasize that non-bloody saliva does not carry risk for transmitting HIV, stating that non-bloody saliva is not considered infectious for HIV. The federal guidelines on HBV and HCV are not as clear. They emphasize that certain non-bloody fluids, including saliva, are unlikely to transmit those viruses (various terms are used in the different guidelines), but do not make specific recommendations regarding follow-up testing. In the absence of clear federal guidelines on follow-up HBV and HCV testing following non-bloody saliva exposures, the PEPline recommendation, above, has taken many factors into consideration. Advantages of follow-up testing include: (1) reassurance for exposed persons who need additional confirmation; (2) documentation of the lack of transmission to confer liability protection; and (3) conformity with local regulations (e.g., state, hospital, or practice protocols/guidelines). Disadvantages of follow-up testing include: (1) increasing confusion and stress from the contradictory messages that the exposure does not confer transmission risk yet months of follow-up testing is to be performed; (2) addressing potential false positive test results, which create personal distress and additional healthcare costs; (3) possibly increasing work-related stress and stress-related health conditions; (4) creating a period of modified sexual practices/interactions and family planning in certain instances; and (5) increasing overall healthcare costs and time away from work. Because the transmission risk of HBV and HCV in exposures to non-bloody saliva, if any, is considered to be negligible and the disadvantages listed above are important, the PEPline does not routinely recommend follow-up testing, but does not take the position that such testing should not occur. • A portal of entry (percutaneous, mucous membrane, cutaneous with non-intact skin) What baseline testing should be performed after an exposure? Is a rapid HIV test accurate enough to decide on whether to give PEP? Deciding Whether to Give HIV PEPWhat is the time frame for using PEP? What is the risk of HIV transmission?
* Note: These estimates are from exposures to blood from HIV-positive source persons; risk for transmission from infectious fluids other than blood is probably considerably lower than for blood exposures. Is PEP always recommended if the source person is HIV positive? Is PEP recommended if the source person has an unknown HIV status? Is PEP recommended if the source person is unknown (e.g. sharps box injury)? Should PEP be given if it is uncertain whether the exposure constitutes a significant risk? What if the source person might be in the “window period” for HIV? Is PEP recommended for a patient who was stuck with a sharp device (e.g. needle, razor) from an unknown source outside of a healthcare setting? How should a human bite be managed? HIV PEP: What to GiveHow to choose a PEP regimen? PREFERRED 3-DRUG HIV PEP REGIMEN: Truvada™ 1 tablet by mouth once
daily PLUS Raltegravir (Isentress®; RAL) 400mg by mouth twice daily Duration: 28 days Side effects and drug-drug interactions: See below How long is PEP taken? How to monitor and manage side effects of PEP? The most important concern with the preferred regimen, tenofovir DF/emtricitabine plus raltegravir or dolutegravir, is potential renal toxicity from tenofovir DF. This regimen should be used with caution in persons with impaired renal function or who are at high risk for impaired renal function. Lab monitoring for drug toxicity: Check CBC, renal and hepatic function tests at baseline and two weeks after starting PEP. What are common drug-drug interactions between PEP and the exposed person’s medications? ALTERNATIVE REGIMENS FOR PATIENTS WITH RENAL DYSFUNCTION (creatinine clearance ≤ 59mL/min): Zidovudine plus lamivudine (co-formulated as Combivir®) PLUS raltegravir or dolutegravir. See raltegravir and dolutegravir caution, above. ALTERNATIVE REGIMENS*
* The alternative regimens are listed in order of USPHS preference. Newer antiretroviral medications have become available since the USPHS occupational PEP guidelines were updated in 2013, and other alternatives using these newer medications may be reasonable based upon patient and clinician preference. Note: For additional information on dosing, drug-drug interactions and toxicities, and toxicity monitoring, see the antiretroviral drug tables found in
the Pharmacy section of the NCCC website. ARV drug dosing and toxicity monitoring *
* Note: For additional information on dosing, drug-drug interactions and toxicities, and toxicity monitoring, see the antiretroviral drug tables found in the Pharmacy section of the NCCC website. Pregnancy and BreastfeedingHow should HIV exposures in pregnant people be managed? Special considerations PEP options for persons who are pregnant or breastfeeding
or
Other PEP options can be considered in the event of intolerance, source persons with resistant virus, medication access challenges, or EP preference. In these instances, providers should seek expert consultation. How should HIV exposures in lactating exposed persons be managed? Special considerations: Exposures to HBVHow are exposures to HBV managed? Recommendations for Post-Exposure Prophylaxis After HBV Exposure
How soon do hepatitis B vaccine and HBIG need to be given? Exposures to HCVHow
are exposures to HCV managed? Recommendations for HCV Testing Following Occupational Blood-Borne Pathogen Exposure Source Person Testing 1
Exposed Person Testing 1
Follow-Up Testing of the Exposed PersonHIV Note: The PEPline recommends final follow-up testing at 3 months. Although the original CDC Guidelines (and many hospital and other protocols) recommend testing to 6 months (or 4 months if testing is performed with the 4th generation Ag/Ab test), delaying follow-up testing beyond 3 months is not necessary with the standard HIV test that is widely used at this time, and can add additional months of anxiety for exposed persons and their families. This PEPline recommendation is consistent with the USPHS non-occupational PEP Guidelines. The USPHS occupational guidelines have not yet been updated to reflect this protocol change. • Extended HIV testing to 12 months is indicated only for HCP who actually acquire HCV infection after exposure to an HCV-HIV co-infected source person. HBV (See Exposures to HBV) HCV (See Exposures to HCV) Guidance for Exposed PersonsWhat do I do if I am the exposed individual? Which blood test is a non specific method and most helpful for evaluating the severity and course of an inflammatory process?C-Reactive Protein
CRP concentrations are a reliable early indicator of active systemic inflammation because they can help differentiate inflammatory from noninflammatory conditions and reflect the severity of the inflammatory insult.
For which patient would the clinician recommend HIV testing?Recommendation Summary
The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk of infection should also be screened.
Which household solution should be used to clean a bathroom if sharing with a friend who has HIV?Surfaces (e.g. floors, countertops, sinks, showers, bathtubs) visibly soiled with blood or excretions should be cleaned with a household detergent or disinfectant (freshly prepared solution of one part household bleach with 10 parts cold water will kill HIV and other germs).
Which solution should be used when irrigating lacerated tissue over a wound on the arm?Saline or tap water may be used for wound irrigation, whereas povidone-iodine, detergents, and hydrogen peroxide should be avoided. The sting from a local anesthetic injection can be decreased by slow administration and buffering the solution.
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