New to the Guidelines

• PEP is no longer routinely recommended for non-occupational exposure when an HIV-positive source has an undetectable viral load
• Tenofovir and emtricitabine or tenofovir and lamivudine are recommended as the preferred 2-drug PEP regimen
• Dolutegravir or raltegravir or rilpivirine are recommended as the preferred third agent for 3-drug PEP
• The PEP course should be extended by 28 days from the last HIV exposure risk
• PEP is discussed in the context of pre-exposure prophylaxis (PrEP)
• Routine monitoring of blood tests at week 1 is no longer recommended
• Advice has been added regarding:
  • PEP and children
  • renal disease
  • gender identity and history.

Before you Begin

The experience of presenting for PEP can be stressful in itself. Research has documented cases where people stated they did not re-present for PEP due to a previous negative experience and then later seroconverted.² Therefore, it is important that clinicians respond to each presentation in a non-judgemental way, using non-stigmatising language.

To be effective, initiation of PEP needs to occur within 72 hours, the earlier the better. Emergency Departments (ED) are busy environments with competing demands. People requiring PEP during business hours should be encouraged to present to the existing options of s100 prescribing GPs or sexual health clinics with levels of staffing able to meet this ad hoc demand where this is available. In geographical areas where these options are not available, or in cases that require attention outside of business hours, people should present to their nearest hospital ED. Training for ED staff should include the necessity to triage, assess and treat these patients with the appropriate priority.