A recent high-risk exposure (within 72 hours)
A course of non-occupational post exposure prophylaxis (nPEP) may be required if a patient is on daily PrEP, or on-demand† PrEP and had a recent high-risk exposure (within 72 hours) but only if they did not take PrEP during those days. This nPEP may need to consist of a three-drug regimen, depending on the nature of the exposure. See […]
Indeterminate HIV test results in the first 3 months on PrEP
There is a potential for PrEP to delay or attenuate seroconversion in people who may have been exposed to HIV just before starting PrEP, or who acquire HIV infection while taking PrEP (e.g. due to poor adherence or transmitted drug resistant virus) 4-6. There is not a broad international agreement on how to manage these patients. Patients who […]
A positive HIV test result
Any positive HIV test result should be managed urgently by appropriate counselling and referral to an HIV prescriber. Assistance can be sought via telephone from a local sexual health clinic. It is very important for the clinician to recognise that HIV acquisition in a person who is using PrEP is a highly significant event and that the emphasis […]
Testing for HIV
HIV testing should be repeated every 3 months using a fourth generation HIV antibody and antigen test via a venous blood draw. Rapid point-of-care tests, including the recently approved home testing HIV diagnostic kit, the Atomo HIV Self Test, should not be used for monitoring patients receiving PrEP. A patient’s ongoing HIV risk and adherence to PrEP […]
Recommended schedule of testing and follow-up for individuals on PrEP
Once pre-exposure prophylaxis (PrEP) is initiated, patients should return for follow-up every 3 months. Clinicians may wish to see patients more frequently in the period after PrEP initiation (e.g. 1 month after initiation) to: assess and re-confirm human immunodeficiency virus (HIV)-negative test status in patients with a recent pre-PrEP HIV exposure assess side effects monitor renal function in […]
References
Grant RM, Lama JR, Anderson PL, et al; iPrEx Study Team. Preexposure chemoprophylaxis for HIV preventionin men who have sex with men. N Engl J Med 2010;363:2587-99. McCormack S, Dunn DT, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised […]