Individuals who are on PrEP
Switching from PrEP to PEP is only recommended if:
- the exposure risk warrants 3-drug PEP, AND
- adherence to PrEP has been < 4 doses in the week of the exposure(s), AND
- the last exposure event occurred within the 72-hour PEP window.
See Table 8 for guidance. If switching from PrEP to PEP occurs in an emergency department, expert advice should be sought and the individual referred back to their PrEP prescriber as a matter of urgency.
If the individual is presenting for PrEP and they have had a possible exposure within the last 72 hours, they should be offered PEP and can then be transitioned to PrEP once confirmed to be HIV-negative.
Table 8. Switching from PrEP to PEP
|Risk event||Adherence to PrEP||Recommendations|
|Requires 3-drug PEP||At least 4 doses in the week of the risk event(s)||Continue PrEP.
Consider risk-reduction counselling.
|Requires 3-drug PEP||< 4 doses in the week of the risk event(s)||Transition to 3-drug PEP if last risk event is within the 72-hour PEP window.
Thoroughly assess context of adherence difficulty and intervene.
Test for HIV at PEP initiation and completion.
Re-commence PrEP on completion of 28 days of PEP.
Reassess adherence and consider increasing frequency of monitoring.
|Requires 2-drug PEP||< 4 doses in the week of the risk event(s)||Continue PrEP.
Thoroughly assess context of adherence difficulty, intervene and increase monitoring.
Test for HIV.