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.