HIV Post-exposure prophylaxis (PEP/PEPSE) supporting guidelines (Guidelines)

01/08/24

• Additional baseline bloods to include Syphilis and HepC (in addition to HIV and HepB)
• Change from the risk calculation tables to the narrative risk assessment table used by BASHH
• Corresponding update of table to include qualification (in new box beneath table) for when HBIG should be given
• Within that advice timing of follow up bloods relevant to Primary Care / Occ health / HSH adjusted from:
  1. HIV at 3/12, HepB Surface Ag (HBsAg) at 6/52, 3/12 and 6/12, HepC at 6/12
  2. To: HIV at 8 weeks (supposed to be 45 days but 8 weeks easier to remember), HepB Surface Antigen (HBsAg) and HepC antibodies at 3/12, But if HepC deemed high risk possibility additional test, HepC Antibodies at 6/12
• Issue raised that LFTs needed to be added to HSH referral document (Document actually sits with HSH / BH). This has been added
• Indication that the dose of Raltegrevir was going to be increased to 2 x 600mg once daily. 
• Change to dosing regime to take account of move to 600mg x 2 tablets once daily
• Change of outcome of risk assessment from 'Give PEP' to 'Recommend PEP'

Sept 2021:

• Benefits of PEP outweigh risks when overall risk of acquiring the infection is >1/1000
• Risk represented by the source patient is now related to risk of 'detectable' HIV
• Window within which PEP should be administered post exposure has increased from 2hrs to 24hrs
• Guidance is that PEP should not be offered simply because of patient anxiety over possible exposure but on more objective evaluation of the risk. (Linked with this it should be noted the 'All clear' can potentially be given a month earlier if a patient hasn't been given PEP)
• Where PEP not recommended for NHS staff and students Occ Health provide follow up. For other patient GP manages follow up.
• Updated Hep B immunisation schedule updated to match 'The Green Book'. This includes that Hep B vaccine can be given up to 1 week post exposure (although ideally within 24hrs)
• Starter pack may become 7 days (rather than 5 days)
• Indication that Raltegravir dosing may be changing to 2 x 600mg daily
• These drugs do not affect hormonal contraception
• Adjusted advice on breast feeding