PEP would not be recommended in any type of exposure when the index case has HIV, is taking antiretroviral treatment for at least 6 months and its viral load is undetectable.
The British HIV and Sexual Health Association (BASHH) and the British HIV Association (BHIVA) have updated their recommendations for the use of post-exposure prophylaxis (PEP). English) against HIV after sexual, occupational or other non-occupational exposure. The first edition was published in 2015 and had an approach based exclusively on the use of PEP after sexual contact. The update aims to provide evidence-based guidelines to facilitate good practice in the use of PEP by healthcare professionals involved in prescribing it.
The guide looks at when to prescribe PEP, what antiretroviral treatments to use, and how to follow up on the people for whom it is prescribed.
In order to meet these objectives, the guide includes data on the efficacy of PEP, evidence related to the efficacy of antiretroviral treatment to prevent HIV transmission, data on the prevalence of viral detectability - that is, transmissibility - in specific populations, a assessment of the risk of HIV transmission based on the type of exposure, tools for the initial risk assessment, data on the various combinations of antiretrovirals analyzed as PEP, information on the follow-up tests to be performed, information to adequately monitor people in PEP and information on what role PEP should play within combination HIV prevention (ie within a preventive strategy that also includes pre-exposure prophylaxis [PrEP], use of condoms and lubricant, etc. .).
The guide also details the use of PEP in special situations such as pregnancy, breastfeeding, in people with chronic hepatitis B virus infection, and when it would make sense to use PEP in people on PrEP.
The guidelines recommend offering PEP routinely if the person has had receptive anal or vaginal intercourse without a condom with a person with unknown HIV status or known HIV infection, but their viral load is detectable or unknown. this information (understood as having a last undetectable analysis and that this has taken place within the last 6 months).
If the exposure to HIV has been occupational or if the exposure has taken place by sharing syringes or material for injecting drugs, the guide considers that PEP should be offered routinely if the index case has known HIV infection and viral load is detectable or unknown.
In the case of insertive sex without a condom, the guidelines suggest that PEP should be considered - although not routinely offered - if, in an anal relationship, the index case does not know its serological status or if, in a vaginal relationship, the index case you have known HIV infection and your viral load is detectable or this information is unknown.
In general, PEP would not be recommended in the following scenarios - and should only be considered in the case of a specific and clear factor that increases the risk of transmission -: in the case of injuries with sharps or splashes, the sharing of equipment for injection or receptive vaginal intercourse when the serological status of the index case is unknown; and in the case of a human bite when the index case has known HIV and its viral load is detectable or unknown.
The first-line PEP regimen of choice considered in the guideline is the combination of raltegravir (Isentress®) and tenofovir disoproxil fumarate (TDF) / emtricitabine (generic drug [EFG], Truvada®) administered for 28 days. PEP should be started immediately after exposure and preferably within 24 hours and should not start after 72 hours after exposure.
The guidelines are clearly oriented to health professionals directly involved in the prescription of PEP, as well as to the various health managers, activists and / or professionals of public entities or organizations that work in the prevention of HIV and / or sexual health.
Source: Self made (gTt).
Reference: BASHH, BHIVA. UK Guideline for the use of HIV Post-Exposure Prophylaxis 2021.