Intended for healthcare professionals

Practice 10-Minute Consultation

HIV prevention with postexposure prophylaxis-in-pocket (PIP)

BMJ 2023; 382 doi: (Published 02 August 2023) Cite this as: BMJ 2023;382:e076016
  1. Maxime J Billick, general internist and infectious diseases fellow12,
  2. Jordana Sheps, family physician and sexual health physician3,
  3. Isaac I Bogoch, general internist and an infectious diseases consultant and scientist124
  1. 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
  4. 4Divisions of Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to: I I Bogoch Isaac.bogoch{at}

What you need to know

  • Postexposure prophylaxis-in-pocket (PIP) is an HIV prevention strategy that may be particularly suitable for people who have only a low number of high risk, often unanticipated, HIV exposures per year (such as 0-4 per year)

  • Prescribing postexposure PIP involves proactively providing 28 days of guideline-approved HIV postexposure prophylaxis so that people may self initiate medications after a potential HIV exposure

  • Evaluate HIV risk at follow-up visits as people may change their preferred HIV prevention modality (for example, between postexposure and pre-exposure prophylaxis) as their needs and circumstances evolve

Patient 1: A 47 year old man taking HIV pre-exposure prophylaxis presents to a primary care clinic for a routine follow-up visit. He is considering entering a monogamous relationship with a male partner, but is uncertain if he may have “very infrequent” sex with other partners. He is wondering whether to discontinue pre-exposure prophylaxis.

Patient 2: A 36 year old woman who engages in sex work presents to a sexual health clinic for symptoms of a sexually transmitted infection. She routinely uses condoms but says that this infection was acquired in the context of non-consensual condomless sexual activity at work.

Patient 3: A 68 year old man who identifies as bisexual presents to an HIV clinic after initiating a postexposure prophylaxis starter pack in an emergency department. He sought urgent care because, although he ensures condoms are worn almost all of the time, he was having receptive anal intercourse with a person of unknown HIV serostatus whom he met on a dating app and the condom broke.

Patient 4: A 25 year old woman presents for follow-up to a general infectious disease clinic for evaluation of a skin and soft tissue infection. She uses drugs intravenously. She tells you she almost never shares injection paraphernalia but ran out of supplies and shared …

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