Post-exposure prophylaxis

Published: 01 October 2011

PEP should be considered after an exposure with the potential to transmit HIV, based on the type of body fluid or substance involved, and the route and severity of the exposure. The DH guidance1 considers that there are three types of exposure in healthcare settings which are associated with significant risk:

(i) percutaneous injury (from needles, instruments, bone fragments, significant bites which break the skin etc.);

(ii) exposure of broken skin (abrasions, cuts, eczema etc.);

(iii) exposure of mucous membranes including the eye.

If that initial assessment indicates that an exposure has been significant (with the potential for HIV transmission), consideration should then be given to the HIV status of the source patient. Medical records may identify whether he or she has been diagnosed with HIV. If the patient’s HIV status is not known, the patient can only be tested with his or her informed consent. As part of pre-test discussion, the source patient should be informed about the incident and the reason for the enquiry, and to whom the results will be disclosed.

It is recommended that all hospitals have the capacity to obtain an HIV test result within eight hours and not more than 24 hours after source blood is taken. Starting PEP, where appropriate, should not be delayed to await the result of source patient testing.

Where it is not possible to identify the source patient (e.g. needlestick injury caused by a discarded needle), a risk assessment should be conducted to determine whether the exposure was significant. This will be informed by considering the circumstances of the exposure and the epidemiological likelihood of HIV in the source. However the Department of Health guidance states that the use of PEP is unlikely to be justified in the majority of these cases.

For optimal efficacy, PEP needs to be commenced as soon as possible after exposure, ideally within an hour. PEP is generally not recommended beyond 72 hours post-exposure. It is therefore recommended that starter packs of the recommended drugs should be readily available in hospital settings.

Moreover, every NHS employer should have a copy of the policy on the management of exposures, which should specify the local arrangements for risk assessment, advice and the provision of PEP. This policy must ensure that adequate 24-hour cover is available.

All healthcare workers, both in hospital and community settings, should be informed and educated about the possible risks from occupational exposure and should be aware of the importance of seeking urgent advice following any needlestick injury or other occupational exposure.

Pregnancy is not necessarily a reason not to take PEP. A pregnant healthcare worker who has experienced an occupational HIV exposure should be counselled about the risks of HIV infection, about the risks for transmission to her baby, and what is known and not known about the benefits and risks of antiretroviral therapy for her and her baby, to help her reach an informed decision about the use of PEP.

More information on post-exposure prophylaxis is provided in an earlier section.

References

  1. Department of Health HIV post-exposure prophylaxis: Guidance from the UK Chief Medical Officers’ Expert Advisory Group on AIDS. London, 2008
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.