Prescribing Post-Exposure Prophylaxis Following Sexual Exposure (PEPSE)

prescribing Post-Exposure Prophylaxis Following Sexual Exposure (PEPSE)

Seek expert advice and consult local guidelines.

PEP is not considered 100% effective, as there have been cases of HIV acquisition whilst on PEP. These may be related to

• delayed initiation
• transmission of resistant virus
• variable genital tract drug penetration
• poor/non-adherence
• further high risk sexual exposures

Recommendations of British Association of Sexual Health and HIV (BASHH):

• PEPSE should be used where there is a significant risk of HIV transmission
• HIV status of source is
  • unknown - proactive attempts are made to establish the HIV status
  • known to be positive
    • attempts should be made at the earliest opportunity to determine the HIV viral load, resistance profile and treatment history
    • PEPSE is no longer recommended if the source is on antiretroviral therapy (ART) with a confirmed and sustained (>6 months) undetectable plasma HIV viral load (<200c/ml)
      • however, if there are any doubts about the HIV viral load history or the source "s adherence to ART then PEP should be given following unprotected receptive anal intercourse
• truvada and raltegravir is the regimen of choice for PEPSE
• PEPSE should be initiated as soon as possible after exposure, preferably within 24 hours, but can be considered up to 72 hours
  • giving PEPSE beyond 72 hours is not recommended
• duration of PEPSE should be 28 days
• follow-up HIV testing at 8-12 weeks after exposure should be carried out
• pregnancy testing should be undertaken in women considering PEPSE
  • pregnancy should not alter the decision to start PEPSE
  • women must be counselled that antiretroviral agents used for PEPSE are unlicensed in pregnancy and risks / benefits must be carefully discussed
• in the event of a further high-risk sexual exposure in the last two days of the PEPSE course the PEP should be continued for 48 hours after the last high-risk exposure
• if the HIV test is positive after PEPSE has already been initiated we recommend continuing PEPSE pending review by an HIV specialist
• individuals experiencing a skin rash or flu-like illness during or after taking PEPSE should be advised to attend for urgent review to exclude an HIV seroconversion illness

Guidance on missed doses of PEPSE:

• <24 hours elapsed since last dose - take missed doses immediately and subsequent doses at usual time
• 24-48 hours elapsed since last dose - continue PEPSE
• >48 hours since last dose - recommend to stop PEPSE (1)

summary of PEPSE prescribing recommendations

Reference:

• (1) https://www.bashh.org/documents/PEPSE%202015%20guideline%20final_NICE.pdf