Preventing HIV: What Every Clinician Needs to Know about Non-Occupational Post-Exposure Prophylaxis

By Varsha Koripella, M2, Wayne State Medical School, Terri L. Wilder, MSW, Mt. Sinai Institute for Advanced Medicine, Antonio E. Urbina, MD, Mt. Sinai Institute for Advanced Medicine

This is part 3 in a 4 part series of articles detailing New York’s efforts to combat HIV through PrEP and other regiments

If a patient presents to a medical provider with a recent HIV exposure, immediate nPEP (non-occupational post-exposure prophylaxis) administration may prevent HIV transmission. This 28-day regimen is recommended for exposed patients of at least 13 years of age, and the recommended regimen is tenofovir + emtricitabine plus either raltegravir or dolutegravir. Situations that prompt a request for nPEP include condom slippage, breakage or lapse in use, and unsafe needle-sharing.

The NYS Department of Health nPEP guidance states: for maximum effectiveness, nPEP must be administered within 36 hours of exposure, ideally within two hours. If the source person is known to be HIV-infected, the provider should obtain information about his/her viral load and antiretroviral medication history, but do not delay administration of the first dose. After administration, telephone or in-person consultation with an experienced HIV provider is recommended. To speak with a clinician experienced in managing nPEP, call the CEI Line toll-free 24/7 at 1-866-637-2342.

When deciding whether to prescribe nPEP, the clinician should assess the patient’s risk of HIV acquisition based on the type of exposure. The behaviors that confer the highest risk are needle-sharing and receptive anal intercourse with an HIV-infected person. Treatment of these exposures should be combined with a strong educational component that emphasizes prevention of future exposures.

All patients receiving nPEP should be re-evaluated within 3 days of the exposure and weekly during the recommended 28-day regimen to assess adherence and side effects. In addition to the baseline test, HIV testing should also be done at week 4 and week 12 post-exposure regardless of whether nPEP was initiated. If the HIV test result is positive at any time, perform a FDA-approved confirmatory assay to confirm the diagnosis. A negative HIV test result at 12 weeks post-exposure reasonably excludes HIV infection related to this exposure.

A member of the health care team should provide risk-reduction counseling whenever someone is assessed for nPEP, and medical providers should assess for other factors that can contribute to risk behavior. Persons who present with repeated high-risk behavior should be the focus of intensified education and considered for initiation of pre-exposure prophylaxis (PrEP).

Are you up-to-date on nPEP?

The NYS Department of Health Clinical Education Initiative (CEI) provides free CME/CNE trainings on nPEP for medical providers in NYS. To request training or to view online nPEP courses, please visit www.ceitraining.org.

The complete NYS DOH PEP guidelines can be found at http://www.hivguidelines.org.

References

  1. HIV Clinical Resource. NYS Department of Health AIDS Institute, Oct. 2014. Web. 8 June 2015. <http://www.hivguidelines.org/clinical-guidelines/post-exposure-prophylaxis/hiv-prophylaxis-following-non-occupational-exposure/&gt;
  2. “I might have been exposed to HIV. What should I do?” Web. 8 June 2015. <http://www.hivguidelines.org/wp-content/uploads/2013/12/i-might-have-been-exposed-to-hiv.-what-should-i-do.pdf&gt;.
Advertisements

0 Responses to “Preventing HIV: What Every Clinician Needs to Know about Non-Occupational Post-Exposure Prophylaxis”



  1. Leave a Comment

What do you think?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s




Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 988 other followers

Follow NYACP on Twitter

Archives

Advertisements