1. Post Exposure Prophylaxis for HIV
Dr Abhimanyu Makane
MBBS CHIV FHM(CMC,Vellore) AAHIVS
Consultant HIV Physician
Sterling Multispecialty Hospial,Nigdi,Pune
Aditya Birla Memorial Hospital,Pune

2. Can someone become HIV negative after diagnosis???
Mississippi Baby
The Berlin Patients

3. Outline Principal changes from previous PEP guidelines
Health care personnel and exposure
Risk of transmission of HIV
Recommendations for the management of person potentially exposed to HIV
HIV PEP
Source patient testing
Timing and duration of PEP
Selection of PEP drugs
Follow-up of exposed person
Post-exposure testing
Monitoring and management of PEP toxicity

4. Basis of Presentation WHO Adult ARV guidelines supplement- Dec 2014
DHHS Aug 2013 PEP guidelines

5. Principal Changes from Previous PEP Guidelines
Elimination of risk stratification for exposure incidents
3-drug (or more) PEP regimen for all

6. Occupational Risk Exposures in HCP
Percutaneous injury (needle-stick, cut) OR
Contact of mucous membrane or non- intact skin
WITH:
Blood
Tissue
Other potentially infectious body fluids- (CSF, synovial, pleural, pericardial, peritoneal, or amniotic fluids; semen or vaginal secretions)

7. NOT Considered Infectious for HIV
Feces
Nasal Secretions
Saliva
Sputum
Sweat
Tears
Urine
Vomitus

8. Risk of Transmission of HIV

9. Assessment of the exposed person
4th generation ELISA for HIV
HBV
Vaccination status

10. Source Patient HIV Testing
If possible, determine the HIV status of exposure source
Unknown HIV status
Window period
HBV
HCV

11. Timing and Duration of PEP
Effect inversely proportional to time to initiation
ASAP preferably within hours
Point at which no benefit -not defined
PEP should be taken for 4 weeks, if tolerated
Appeared protective in occupational and animal studies

12. Post-exposure prophylaxis ARV regimens-for Adults
TDF + 3TC (or FTC)
The preferred backbone
RAL, LPV/r, ATV/r or DRV/r
Preferred third drug
EFV
Alternative options

13. ARV contraindicated as PEP
Nevirapine

14. Special Considerations
Pregnant
Breastfeeding
Paediatric

15. Follow-up of Exposed Patient
If 4th-generation (p24 Ag/HIV Ab test) is used:
HIV testing at baseline, 6 weeks, 12 weeks after exposure
Barrier Protection for partner protection
Close follow-up to diagnose toxicities early

16. Assess Prescription Followup Counsel & Support
• Clinical assessment of exposure
• Eligibility assessment for HIV PEP
• HIV testing of exposed people and source if possible
Counsel &
Support
• Risk of HIV
• Risks and benefits of HIV PEP
• Adherence counselling if PEP to be prescribed
Prescription
• PEP should be initiated ASAP post exposure
• 28-day prescription
Followup
• HIV test at 3 months after exposure
• Link to HIV treatment if possible
• Provision of prevention intervention as appropriate