Post-Exposure Prophylaxis for HIV

Introduction to PEP

The Centers for Disease Control and Prevention recommends that post-exposure prophylaxis (PEP) for HIV should be initiated as soon as possible, ideally within 24 hours but no later than 72 hours after potential HIV exposure, and continued for 28 days to prevent HIV infection 1, 2

PEP should be offered in situations where exposures occur within the past 72 hours, ideally started within 24 hours, to individuals exposed to bodily fluids that pose significant risk, such as blood or blood-stained fluids, breast milk, or certain other bodily fluids 1, 2, 3, 4, 5
The World Health Organization and the Centers for Disease Control and Prevention suggest that PEP is not recommended when the exposed individual is already HIV-positive, when the source is confirmed HIV-negative, or for exposures to bodily fluids that don't pose significant risk 3, 4

A rapid risk assessment should be performed to evaluate the type of exposure and HIV status of the source when possible, and HIV testing of the exposed person should be done without delaying PEP while awaiting results 3, 4, 1
PEP should be started as soon as possible, ideally within 24 hours, and the source's HIV status should be determined when possible 1, 2, 3, 4

The Centers for Disease Control and Prevention recommends the following preferred regimens for adults and adolescents: Bictegravir/emtricitabine/tenofovir alafenamide or Dolutegravir plus tenofovir alafenamide or tenofovir disoproxil fumarate plus emtricitabine or lamivudine 1, 2
The World Health Organization recommends TDF plus 3TC or FTC as the backbone regimen, plus LPV/r or ATV/r as the preferred third drug 3, 5

PEP should be completed for a full 28-day course, and follow-up testing should be done within 24-72 hours, at 4-6 weeks, and at 12 weeks after exposure, with HIV testing concluded at 4 months if using newer fourth-generation combination tests 1, 2

For individuals with ongoing HIV risk, consider transitioning directly from PEP to PrEP after completing the PEP course and confirming HIV-negative status, as recommended by the Centers for Disease Control and Prevention 1, 6
PEP should be offered promptly without waiting for risk assessment results in sexual assault cases, according to the Clinical Infectious Diseases guidelines 4