A multidisciplinary Expert Reference Group (see Acknowledgements) was convened by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) in March 2022. The updated guideline is based on a comprehensive literature review conducted by a trained librarian from an Expert Reference Group member’s Institution (Walter McGrath Library, St Vincent’s Hospital, Sydney).
The search included dates from January 2015 to January 2022 and for literature in English. Databases searched were: the Cochrane Library, EMBASE (Ovid) and Medline 1996 – (Ovid). Public search engines such as Google were used to locate documents on the management of HIV exposures nationally and internationally. Keywords searched were ‘post-exposure prophylaxis’ or ‘post exposure prophylaxis’ or ‘PEP’ or ‘nPEP’ or ‘oPEP’ or ‘occupational exposure and HIV’ or ‘nonoccupational exposure and HIV’.
The formal review process was further informed by searches of the reference lists from publications of interest; grey literature and citations were also reviewed. The grey literature included: conference presentations, project reports, government reports, policies and strategies, and healthcare organisation publications. PEP guidelines and reference lists from the UK (2021),120 the US Centers for Disease Control (2016),121 and the World Health Organisation (2014)122 were also reviewed.
Expert Reference Group member, John McAllister, calculated the risk of viraemia in various subpopulations in Australia (Appendix A), on which PEP recommendations for a person following exposure with a source was calculated using available data, including Australian Census data and National HIV surveillance data.47-50,123-127
Final recommendations were developed following five meetings and regular email correspondence between Expert Reference Group members on original drafts, comments and recommendations. David Templeton drafted the, Introduction, Background: evidence supporting the efficacy of PEP in preventing HIV acquisition, Evidence for two-drug versus three-drug PEP regimens, Antiretroviral agents not generally recommended for PEP, Side-effects of recommended PEP medications, Drug-drug interactions with PEP medications, Management of possible exposure to other conditions: Pregnancy and lactation and Adult sexual assault (>16 years of age). Charlie McLeod, Brendan McMullen and David Templeton drafted Additional Clinical Management Issues: Children younger than 16 years of age. Anna Pierce drafted Management of possible exposure to other conditions: Hepatitis B and Hepatitis C. Caroline Thng drafted Specific clinical situations for PEP: People who re-present for PEP after completion of a PEP course, People who re-present with additional high-risk exposure(s) while taking a PEP course and People who are on PrEP. Charlotte Bell drafted Clinical assessment and Specific clinical situations for PEP: People at negligible risk of HIV transmission who request PEP. David Lee drafted Management of possible exposure to other conditions: Sexually transmissible infections. Donna Tilley drafted Laboratory testing for HIV PEP recipients, Prescribing PEP, Specific clinical situations for PEP: People at risk of HIV acquisition who decline PEP and People who are transitioning from PEP to PrEP. John McAllister drafted Assessment of the risk of HIV transmission and When to Prescribe PEP. Louise Owen, Sarah Martin and Anna Pierce drafted Important note for general practitioners who have not previously prescribed HIV PEP. David Templeton was responsible for checking the accuracy of supporting references and writing the final version of the revised guideline.