In January 2003 guidelines which covered the use of PEP following non-occupational exposure to HIV were published in the Journal of the American Medical Association (JAMA).

The 30-page document, Nonoccupational Human Immunodeficiency Virus Postexposure Prophylaxis Guidelines for Rhode Island Healthcare Practitioners, is online on the websites of the Rhode Island Department of Health (http://www.healthri.org/media/020925a.htm) and the Brown University AIDS Program (BRUNAP) (http://www.brown.edu/Departments/BRUNAP/backnpep.htm).

Seven countries—six European nations and Australia—have adopted HIV non-occupational PEP guidelines. The US Centers for Disease Control and Prevention reviewed the issue in 1998, but has not issued formal guidelines on its use. Currently, California and New York have guidelines for PEP for victims of sexual assault, but not for people who sustain other types of potential HIV exposure.

A clinical advisory had been issued by the Massachusetts Department of Public Health in October 2000 to medical providers in the state to inform them that HIV-risk assessment and PEP "should be considered for individuals who present within 72 hours of a high-risk sexual or other non–health care related exposure." The department also recommends that clinical settings offering non-occupational PEP establish written protocols that incorporate certain elements regarding assessment, treatment, and follow-up. The advisory can be read online at:  http://www.state.ma.us/dph/aids/guidelines/exposure_nonwork.htm

The guidelines recommend that clinicians in Rhode Island first assess the risk of HIV exposure. According to the guidance, non-occupational PEP should be offered following possible exposure with a person known to be HIV-positive. It may also be offered after high-risk exposures (such as unprotected sex with a person who has had multiple sexual partners or is an injecting drug user), and may be considered if a person has had a low risk exposure (such as an unprotected sexual contact with a person of no recognised risk behaviours for HIV). When possible, the HIV serostatus of the source should be determined.

The guidelines suggest that, when offered, treatment should be provided within a maximum of 72 hours and preferably within one hour of exposure.

Specific drug regimens are also recommended; following exposure with a person known to be HIV-positive, it is recommended that a triple combination, containing a protease inhibitor be provided for 28 days. Where possible, the clinician responsible for the care of the HIV-positive person should be contacted to obtain details of the contact’s HIV treatment history and known resistance profile.

In all other instances a dual combination should be provided for four weeks. In all cases, people receiving non-occupational PEP should receive information about dosing, potential side-effects, and possible drug interactions. For healthcare professionals, the guidelines include details of which tests should be undertaken on people with possible HIV infection.

The guidelines also include information about appropriate laboratory tests, non-occupational PEP considerations by exposure category (sexual assault, consensual sex, non-occupational needlestick and sharps injuries, injection drug use, and "unusual" exposures to body fluids (such as amniotic fluid), and sample patient instructions.

The Rhode Island guidelines also indicate that certain groups who might benefit from non-occupational PEP should be informed about the option and arrangements should be made for quick access to medications, should the need arise. Such groups include the uninfected partner in serodiscordant couples, as well as people who may be at higher risk of experiencing a needlestick or sharps injury, including non–health care personnel and caretakers of HIV-infected patients, sanitation workers, and housekeeping and commercial cleaning workers.

The guidelines stress that non-occupational PEP is not a substitute for HIV prevention programmes. Dr Ronald Merchant, one of the authors of the Rhode Island guidelines said: “Primary prevention is very important but we need to find other ways [to prevent HIV]” adding, “HIV non-occupational PEP is not the end-all, but it can be one part of our armamentarium for decreasing the incidence of HIV.”