Intended for healthcare professionals

Practice 10-Minute Consultation

HIV post-exposure prophylaxis (PEP)

BMJ 2018; 363 doi: (Published 29 November 2018) Cite this as: BMJ 2018;363:k4928
  1. Mark J Siedner, associate professor of medicine,1 2 3,
  2. Ethan Tumarkin, internal medicine resident4,
  3. Isaac I Bogoch, associate professor of medicine4 5
  1. 1Harvard Medical School, Boston, MA, USA
  2. 2Massachusetts General Hospital, Boston, MA, USA
  3. 3Mbarara University of Science and Technology, Mbarara, Uganda
  4. 4Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Ontario
  1. Correspondence to I Bogoch isaac.bogoch{at}
  • Accepted 8 November 2018

What you need to know

  • HIV post-exposure prophylaxis (PEP) is a safe and effective treatment strategy aimed at preventing infection in those with a recent HIV exposure

  • PEP is typically prescribed as three HIV antiretroviral drugs started within 72 hours after exposure, and continued for 28 days

  • PEP is most useful for people with a single exposure or infrequent moderate-to-high risk exposures to HIV. Pre-exposure prophylaxis may be better suited to those with ongoing risk1617

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 …

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