Post-exposure prophylaxis (PEP) for HIV

Timing

When HIV PEP is required, start as soon as possible, ideally within 1h of a Significant Exposure, but no later than 72h; PEP is ineffective if started after 72h.
If it is known/highly likely the source is HIV positive, PEP can be started immediately pending the outcome of a more thorough risk assessment.
Where laboratory staff working with drug-resistant virus are exposed, an immediate expert opinion must be obtained from the ID consultant on-call.
OHS Nurses should also contact the ID consultant on-call for advice as required.

Before supplying PEP, obtain the following history:
A clear history of the injury including timeline and source risk assessment.
Past medical history.
Drug history, including oral contraception, herbal remedies, over the counter medicines, and recreational drugs.
Females should be asked about possible pregnancy:
Conduct urgent pregnancy testing for any woman who may be pregnant.
Pregnancy is not a contraindication to PEP but may affect the decision process.
These patients can be discussed with the on-call ID consultant.

The current HIV PEP regimen used in NHS Lothian is detailed in Current recommended HIV Post-Exposure Prophylaxis (PEP). A full course is 28 days.

7-day starter packs of PEP medication are available at:

The doctor providing PEP should print and give to the patient the following leaflets:

Adults: Should be followed up at RIDU within 48-72 hours so that a decision can be made on continuing therapy, and any additional concerns can be addressed.
Children: follow-up is with the paediatric ID consultant at RHCYP.
HIV follow up testing is done at 6 and 12 weeks after completing PEP (see Table 1 in Managing significant exposures).
Patients receiving HIV PEP require baseline FBC, U&Es, LFTs and Phosphate, and repeat testing at days 14 and 28.

Patients who refuse PEP but agree to follow up testing should be tested as per Table 1.