PEP Guidelines

Australian National Guidelines for Post-Exposure Prophylaxis (PEP) after Non-Occupational and Occupational Exposure to HIV

Fourth Edition (2025)

Introduction

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Overview

This is the fourth edition of the National HIV post-exposure prophylaxis (PEP) guidelines, which outline the management of individuals who have been exposed (or potentially exposed) to human immunodeficiency virus (HIV) in non-occupational and occupational settings. Risk of transmission, the timing of PEP, baseline assessment, preferred regimen and follow-up are outlined. Also included is the use of HIV PEP in the era of the Pharmaceutical Benefits Scheme (PBS)-subsidised HIV pre-exposure prophylaxis (PrEP).

There is no data from randomised controlled trials of the use of PEP, and evidence for use has been extrapolated from animal data, mother to child transmission, occupational exposure and small prospective studies of PEP regimens in HIV-negative men. Accordingly, the biomedical management of HIV exposures is largely based on expert opinion and limited data.

Every presentation for PEP should be assessed on a case-by-case basis, balancing the potential benefits against the potential risks of PEP recommendation.

Presenting for PEP and disclosing HIV risk behaviour can be a stressful experience and therefore it is important that clinicians are non-judgemental when conducting PEP assessments. A patient’s negative experience when requesting PEP has resulted in failure to re-present for PEP, leading to subsequent HIV acquisition1,2

Although recommended to be given within 72 hours to be effective, the earlier PEP is initiated after the exposure, the better. PEP is available through s100 and other PEP prescribing GPs, specialist nurse practitioners, sexual health clinics, emergency departments and some urgent care clinics. Unlike PrEP, PEP is not available on the PBS; however, now that affordable generic formulations for 2-drug PEP are available, all GPs are able to prescribe 2-drug PEP at a reasonable cost, using a private (non-PBS) prescription (see section “Prescribing PEP”).

This fourth edition of the National PEP guidelines is:

  • Revised from the third edition of the National guidelines for post-exposure prophylaxis after non-occupational and occupational exposure to HIV (2023).
  • Produced by ASHM.
  • Available as a website resource at www.pep.guidelines.org.au
  • Supported by a clinical decision-making tool available here
  • Funded by the Commonwealth Department of Health (DoH).
  • Will be reviewed regularly through ASHM, for advice to the DoH.

Next Update Due: July 2027

A note about source viral load

Although an estimated 87% of all PLHIV in Australia have undetectable viral load3, this does not influence PEP prescribing. If the source VL is unknown, then the risk is still sufficient to prescribe PEP. If the source VL is undetectable, then PEP is not required.

A note about gender identity and history

It is acknowledged that language is ever evolving, and the term trans and gender diverse (TGD) used in this document is inclusive of both binary and non-binary TGD individuals.

Evidence for HIV prevalence and risk among TGD individuals in Australia is poor due to limitations with data collection and recording of TGD status.3,4 Internationally, TGD individuals are often disproportionately affected by HIV.5

It is important for clinicians not to make assumptions about a patient’s gender identity or the type of sex they have. Ask for and use preferred pronouns and names for anatomical sites (e.g. this could be front hole rather than vagina) and use open-ended questions when taking a sexual history. The focus of the PEP risk assessment needs to be the potential HIV risk of the source and type of exposure, rather than the individual’s gender identity.

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