HIV post-exposure prophylaxis (PEP)

A 22 year old man presented to the emergency department for HIV post-exposure prophylaxis (PEP). Twenty six hours previously, he had anal receptive intercourse without a condom with a man of unknown HIV serostatus. He had immediate testing for HIV (using a fourth generation antibody/antigen assay as recommended12), hepatitis B and C serologies, syphilis serology, and urine nucleic acid amplification tests for gonorrhoea and chlamydia. In the emergency department he received a three day supply of combined emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) (one tablet, daily) plus raltegravir (400 mg twice daily). He was referred to be seen urgently in the next three days in an outpatient clinic for continuing management.

PEP is a safe and effective HIV prevention modality for people with a recent (within 72 hours) exposure to HIV. People with HIV exposure often present to primary care clinics and emergency departments, so it is useful for non-specialists to have confidence in prescribing PEP. Clinicians caring for people presenting with a recent HIV exposure require knowledge of recommended diagnostic testing after sexual exposure and blood borne exposure, PEP regimens, schedule of short and long term follow-up, and the potential for physical and psychological trauma (eg, in the case of sexual assault). This article offers practical advice and resources for clinicians caring for individuals who present for care after an actual or potential exposure to HIV that …