PEP Guidelines

Clinical Assessment and Follow-up

In making a clinical assessment, health practitioners should consider the gender, culture, language and literacy level of the person seeking care, and their intellectual capacity. The following details should be discussed and documented in the patient’s history:

Information about the exposure

a. Date and time of exposure

b. Type of exposure, including blood or body fluids involved, trauma, first aid measures applied and any cofactors

c. If the exposure occurred in a context that was consensual or involved coercion, force or lack of consent, as disclosed by the individual. If non-consensual, consider referral for forensic assessment based on patient preference and provide information for ongoing support.

Information about the source person

a. HIV status, if known

b. Demographic factors, e.g. gender, sexual identity, country of origin

c. If HIV positive:

    • plasma HIV viral load, date of last test, medication adherence
    • ART history (has resistance been an issue, if so with which drugs?)
    • recent HIV resistance testing 

d. Current STIs; hepatitis B status

e. Whether the source is known to be taking PrEP.

Information about the exposed person

a. Most recent HIV test and result

b. Other potential HIV exposures since the last negative HIV test

c. Previous use of PEP, including regimen, adherence and side effects

d. Current or previous use of PrEP (see Table 6 for interface between PEP and PrEP)

e. Current symptoms of an STI

f. Previous history of syphilis (to assist with interpretation of a positive syphilis result from baseline testing)

g. Hepatitis B status: if a patient is known to have chronic hepatitis B (HBV), they can be safely commenced on PEP with specialist advice sought before PEP is ceased (see section: Additional Clinical Management Issues).

h. Pregnancy risk, contraception and lactation (consider emergency contraception)

i. Medical history:

    • all medications and drug allergies
    • current and past medical history, including renal disease, psychiatric history and drug and alcohol history.

Information to provide to patients when initiating PEP

  • An explanation of PEP and its indications, effectiveness, risks and benefits, potential side effects, potential drug interactions, the importance of 100% adherence to dosing and regimen completion and what to do if a dose is missed (see Additional Clinical Management Issues).
  • The symptoms of HIV seroconversion (fever, fatigue, myalgia, skin rash, headache, pharyngitis, cervical adenopathy, arthralgia, night sweats, and diarrhoea), with advice to urgently access specialist advice if these or any other symptoms occur.
  • Recommendation to adopt risk-reduction practices (including condoms for vaginal and anal intercourse and sterile injecting paraphernalia) until final HIV testing is complete post PEP completion. 
    Option for transitioning from PEP directly onto PrEP for those at ongoing risk of HIV acquisition.
  • The recommended timing of follow-up HIV and other testing is outlined in Table 4 – Individuals with a positive or indeterminate HIV test on baseline testing, or during follow-up, require immediate referral to an HIV specialist.
  • Referral to mental health, risk-reduction counselling or alcohol and other drug (AOD) services if indicated. 
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